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Intake &Approval Sheet *OR PERMIT STAFF ONLY) •ERMIT# _go.3 /( `- 0077 <br /> BUILDING - PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ebZone <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size (p 4 Nonresidential Use TLUyQ(a'N-11Ep ,tt0 <br /> Garage/Accessory Struct.Size Residential Use _ <br /> Number of Stories [ Proposed No.of Dwelling Units: <br /> Basement ENo ❑Yes, Fin/Unfin Total No.of Dwelling Units:p <br /> Type of Construction h( (� Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group k "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? INNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 J2018 02015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers: El Update Existing El New System 1SNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ / (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System ®Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: , <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 13 No <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes ONo Additional Not <br /> VALUATION CALCULATION: Total$ GO/otib a DP / l 171) <br /> �/�� <br /> A proved y: Da e: <br /> PUBLIC WORKS <br /> Intake OK by: 0 Date: ti 1►�t 1 ii02'2 <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> IOSys Dev Eval: <br /> Additional Notes: 1 ❑Water ❑Sewer OStorm <br /> I <br /> ,,j/,I koloy wm _ IuTraffic Mitigation Eval <br /> Approved By: CA Date: I/t®L ! �1 ia I OSite Work/Drainage(shown/triggered) <br /> IV olnanti oi wCV . in <br /> Address Letter <br /> FIRE DEPARTMENT 10Backflow Prevention for high hazard: <br /> Separate I Deferred Submittals Required: !(dental,medical,r animals,mortuary, <br /> pq :hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: , <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#:PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> •0 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: K i c,�th Date: /f.-/4-.1. ' ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 04 Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By ,1444#10 ate: It ill 11424 <br />