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Intake & Approval Sheet (FOR PERMIT STAFF ONLI9 PERMIT# b2 ? - 0 Ir <br /> BUILDING PLANNING <br /> Intake OK bycZ ,or', Date: O1/'�tl/4D 2-0 Intake OK by: 6142j Assign To: Date: 2.12.dA J_ <br /> Intake Comments: Intake Comments: <br /> Jl f r'�o it -PGA 'Yl9 <br /> izi Route to wilding ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bldqt ddn/Rem Size Sj J(‘ ,s F �❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ti%d Zone / ✓I \ <br /> Number of Stories / Overlay/Agreement <br /> Basement ,lo ❑Yes, Fin/Unfin Nonresidential Use j vtAr-i1 i icLe,31400 <br /> Type of Construction JL-L Residential Use <br /> Occupancy Group F-// Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers:ZiUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System lNot Req'd Schoo t Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Et No ❑Evere o Dist Elmu 1 hool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 13No dditional Notes: <br /> VALUATION CALCULATION: Total$ %C'le -OO <br /> Approved By: / i7 Date.jl 14/2_► <br /> PUBLIC WORKS Intake OK by Ci /71)/ZE)Z,40 <br /> Date: <br /> Additional Notes: Intake/�� Comm je�nts: !PW Worksheet Needed if: <br /> 01 '41 �^""" 1 <br /> ❑(Sys Dev Eval ❑Traffic Mit Eval <br /> tit' �/�1►1 l4 +(f-5r •IJEtSite Work oj j €❑Backflow Prevention for high hazard: <br /> Approved By; >, Dater�� �D7 (�}Y1SA�'�� / ;(dental,medical,animals,mortuary,hospital, <br /> :supportive 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 /> Tire Sprinklers ire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: S ,(,.et_14 IJ This Permit is Approved by Public Works <br /> ISee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: -A Separate PW Permit is Required (Permit#: PW Zoo 2. 0 3 2 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Et1s located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Review/Inspection S pe ADD FIRE FEE El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: g,Kj /u'-/ Date: l/Z5/ j ❑ Public Works has no scope--- PW Not Required <br /> l Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> i / <br /> Approved By: Date: Approved By:1/ ,- �� ' Date: 0Z1z-a I Z63.41, <br />