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Intake&Approval Sheet (F PERMIT STAFF ONLY) P EiliT# 13'aLfO3 --0 %6"
<br /> BUILDING . PLANNIR
<br /> intake OK by: Date: Intake OK by: Assign To(re,,al bate: 3/20,
<br /> intake Comments: Intake Comments:
<br /> Zone H/
<br /> ❑Make this a"W"Permit 0 SRC Required(Pre-Inap) Overlay/Agreement ' 4(,q tI CA-
<br /> Bld I ddn/Rem Size a.Ot3 Nonresidential Use
<br /> g� � yl5. r dffT a_
<br /> Garage/Accessory Struct_Size Residential Use
<br /> Number of Stories I t Proposed No.of Dwelling Units: .
<br /> Basement No DYes, Pin!Unfin Total No.of Dwelling Units: P '
<br /> Type of Construction V k. Planning/Landscape Inspection Required before Final? DYes PNo
<br /> Occupancy Group R f'a. • "In Lieu"Fee:Type: Amount$
<br /> Occupancy Load i*-110 School Impact Fee: Total $ .
<br /> es S Only Calculated: Credit:
<br /> Cert.of Occppancy Required? �No CIY hell n y
<br /> Code Year E12021 I2018 02015 DEverett School Dist DMukIlteo School Dist
<br /> Fire Sprinklers:DUpdate Existing ONew System lONot Req`d Park Impact Fees for perm's applied for after 11112022:
<br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) •
<br /> Fire Alarm: 0Update Existing El New System IL`lNot Req'd Fee Schedule Used For C culatlon(Year):11M14n 41..,,,,,,,,,,,,,,,1M^n �.^ o ^YM w
<br /> Reason Fire Alarm Required:
<br /> ROW 64.55 MF worksheet req'd for permit? DYes ®No ,
<br /> Add'I RCW..64.55 docs required prior to final? DYes [NNo Additional Notes: Der7ce to Dr-A -e-- o• , no e k"'
<br /> VALUATION CALCULATION; Total$ 7(I o0o See_ try p)c ec cry 6.1.9 t2 .at
<br /> Approved By:__ 6, Date: /240/2
<br /> . PUS.LiC WORKS . ,
<br /> IntakeOK by: Date:.-.„,,,,,,,,,nl.,..-...w.-..M-,,,.,,.,.1. .,,,,-1,.,,,,.,-„..,
<br /> • Intake Comments: - IPW Review&Worksheet Neerfed if
<br /> • ,1[(Sys Dev Eval:
<br /> Additional Notes: I ❑Water CiSewer C(Storm
<br /> II:Traffic Mitigation EvaL
<br /> Approved By: (��R ,.� Date- 3 /t y ElSite Workinrainage(shown/triggered)
<br /> • v ! I):Address Letter
<br /> •
<br /> Ping DEPARTMENT ;ClBackfiow Prevention for high hazard:
<br /> Separate 1 Deferred Submittals Required: (dental,medical,animals,mortuary,
<br /> q !hospital,supportive housing)
<br /> •
<br /> Fire Sprinklers ElFire Alarm ❑Other: ( •
<br /> Additional Notes: • El This Permit Is Approved by Public Works •
<br /> See PW Review Worksheet and associated attached items
<br /> Fire Dept Fees: Q A Separate PW Permit is Required(Permit#:PW ) •
<br /> El Review of As-Built Plans-NO FIRE FEE AND ❑Is fully digital
<br /> Li 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(join with this fo(derforpermitIssuance)
<br /> Approved ay: Gt,<\Date: ;z.�24/ El Will be issued separately(separate Green Folder,PW issued ahead of Bldg)
<br /> *Public Works has•no scope on this permit---PW Not Required
<br /> • ELEGTRlCAL1PLIJMBING Additional Notes:
<br /> Additional Notes:
<br /> Approved By: Date: Completed 13 . G'S� - ` Date: 2/I�',(i'
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