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Intake&Approval Sheet 46FOR PERMIT STAFF ONLY) PERMiT# cgt9N4©g — (3( <br /> BUILDING . PONING <br /> Intake OK by: Date: Intake OK by: Assign To: -p b Date: IA MAi ZoZ4 <br /> Intake Comments: Intake Comments: <br /> Zone —I. <br /> ❑Make this a"W"Permit 0 SRC Required(Pro-Inap) Overlay/Agreement ' R;r Port 1'4'1vtwu. /'tn,/4, <br /> BIdg1TUAddn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use S <br /> gt <br /> Number of Stories Proposed No.of Dwelling Units: . . <br /> Basement 9No ElYes, Fin!Unfin Total No.of Dwelling Units: 1 • <br /> Type of Construction W-LC <br /> Planning/Landscape Inspection Required before Final? CIYes No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ 0l PtOccupancy Load - � School Impact Fee: Total $ 14 I R <br /> Cert.of Occppancy Required? tNo ElYes DShell Only Calculated: Credit: <br /> Code Year N2021 02018 E12015 DEverett School Dist DMukliteo School Dist <br /> Fire Sprinklers:D••Update Existing CINew System &lot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park impact Fee Total$ 0 (A (net due after credit for existing uses) <br /> Fire Alarm: 0 Update Existing ElNewSystem SNotReq'd Fee Schedule Used For Calculation(Year): „uuN-,,.,,N M,...,,,.,,,,,..,,,-„n n uM1 uN„„ „nu <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? CIYes IZNo . <br /> Addt ROW.64.65 does required prior to final? IJYes SINo Additional Notes: <br /> VALUATION CALCULATION: Total ii goo _ . <br /> Approved By: , LAW . Date: 2.4 MArA% Solit <br /> ` <br /> l-9e(� ' 4( zr• (1" '°N <br /> P44 -f PUBLIC <br /> Intake OK by: Date: <br /> • Intake Comments: - IFWReview&Worksheet Needed if <br /> • I ,1 DSys Dav Eval: <br /> Additional Notes: 11{ MWater r._iSewer [(Storm <br /> DTraffic Mitigation Eva!, <br /> , <br /> Approved By: LI.ISJA,M,, Date: )f�o/ 1k . IaSite Work/Drainage(shown/tr(ggered) , <br /> • l b fE1Aress Letter <br /> irillE'DEPACRTMl~NT faaackflow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary, <br /> Separate!Deferred Submittals Required: <br /> hospital,supportive housing) <br /> DFire Sprinklers DFire Alarm DOther: I <br /> Additional Notes: , El This Permit is Approved by Public Works . <br /> . El See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: a A Separate PW Permit is Required(Permit#:PW ) <br /> El Review of As-Built Plans-NO FIRE FEE AND El Is fully digital <br /> LI Minimal or No Fire Scope-NO FiRE FEE 0 Is located in this folder <br /> El Review!Inspection Scope-ADD FIRE FEE El is in a Separate Green Folder o?n with this falderfor permit Issuance) <br /> Approved By: Date: , El Will be issued separately(Separate Green Folder,PW issued ahead ofeldg) <br /> Public Works has•no scope on this permit---PW Not Required <br /> EJ..EQTRIGAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: ?5Date: 3/z7i f 7iJ <br /> • <br /> . 33 , <br />