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• <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) P MIT# ‘ <br /> -003 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: ..-0rq Date: t/'.ai4106..tell <br /> Intake Comments: " Intake Comments: <br /> °( I ' <br /> Zone M,\) <br /> ❑Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bidg/TIIAddn/Rem Size ,� , I � z Nonresidential Use C OAMIA.vor-a'st.A <br /> Garage/Accessory Struct.Size t` Residential Use <br /> Number of Stories 1 Proposed No.of Dwelling Units: <br /> Basement 0No DYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction t, M Planning/Landscape Inspection Required before Final? DYes INo <br /> Occupancy Group . '4: yl "in Lieu"Fee:Type: Amount$ /a IA. <br /> Occupancy Load Y School Impact Fee: Total $ N IA- <br /> Cert.of Occpuancy Required? ❑No ' Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 i?.2018. 02015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ❑NewSlystem rSigot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ N IAA (net due after credit for existing uses) <br /> Fire Alarm: Update Existing ❑New System ag44434448441 Fee Schedule Used For Calculation(Year): <br /> - -_ <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes arNo <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes tuNo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: k) , ,mac Date: 1 ftAi1+1 2024 <br /> PUBLIC WORKS <br /> Intake OK by: \�� Date: /"e t 1 202- <br /> Intake Comments: PW Review&Worksheet Needed If: <br /> ) OSys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: 4/4,4,77-e-diatle:_ t, ( t .. - J Mite Work/Drainage(shovm/triggered) <br /> / DAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate I Deferred Submittals Required: <br /> (dental,medical,animals,mortuary, <br /> ❑Fire Sprinklers ►=1 ire Alarmhospital,supportive housing) <br /> DOther: <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required(Permit#: PW_ ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder porn with this folder for permit issuance) <br /> Approved By: c 1 J n Date: 13 —L2 ;,,2/ ❑ Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> VI 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: Pyf AI ) Date: ir)\ 2...12 <br />