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I W Intake & Approval Sheet (FOR PERMIT STAFF IIIP PERMIT# vg64'.o1-"b <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: V,(4,-. . Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ,OK to Route to Other Departments <br /> Bldg/TI/Addn -ern Size .¢-!-e,2-GP 4 ❑ Hold in Planning File Drawer <br /> Garage/Access•‘ Struct. Size 5,2.. -5---(-2. Zone 2- <br /> Number of Stories Overlay/Agreement <br /> Basement 4No /❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction "P' Residential Use `FR. <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Chew System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required': \ "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Updat-txistin2,El New System In Not Req'd ch I I ct e: To;:l $ A A A A A <br /> Reason Fire Alarm Re• ired: cul d: Cr:• <br /> RCW 64.55 MF worksh:-t re 'd for ermjt? El Yes 141 No Eve tt S hoo Dist ' N Mu ilteo .,hootlist <br /> Add'I RCW 64.55 doc• required prior to final? ❑Yes I2,INo Additional Notes: 111,01 (® 5 N� Ave, C`a��VALUATION CALL 4 CATION: Total $` 4-�j 9'4 r <br /> i f htrt; kAs Art e Is-tJ E - <br /> 32>19- 2-I1) = 4cnt , Se- / / <br /> 52 t 4$) 2 ,� O o`i \ Approved By: AO Date: / kJ I�%�1 <br /> PUBLIC WORKS <br /> -----4 <br /> Intake OK by: Date: <br /> Additio .I Notes: \...6 Intake Comments: IPW Worksheet Needed if: <br /> � I DSys Dev Eval ❑Traffic Mit Eval <br /> -'J I DSite Work or Drainage Proposed <br /> Approved By: , I Date: 1/�/';27/ Z,� I.�Backflow Prevention for high hazard: <br /> I / (dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end --- PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional tes: )(cod), Q This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 'p A Separate PW Permit is Required (Permit#: PW2-001— 03 1 ) <br /> ❑ Review of As-Built Plans- NO FIRE FEE t:\`r✓— AND 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE J Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: ''IA Date: z.''1 2.0 <br />