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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 46 PERMIT# -060 <br /> BUILDING . PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone i2-- <br /> ❑Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement Sidewalk-ertovii (yytcl <br /> Bidg/Tl 40"em Size 31 Z S1 Nonresidential Use NI/t <br /> 6.... /Accessory Struct_Size 3 40. tF . Residential Use SPia. <br /> Number of Stories 2 • Proposed No.of Dwelling Units: 0 . <br /> Basement No DYes, Fin 1 Unfin Total No.of Dwelling Units: 1 • <br /> Type of Construction *1.12'L Planning/Landscape Inspection Required before Final? [(Yes JNo <br /> Occupancy Group "In Lieu"Fee:Type: 0 Amount$ (7) <br /> Occupancy Load School Impact Fee: Total $ P <br /> Cert. of Occpuancy Required? liNo DYes QShell Only Calculated: (6 Credit: 95 <br /> Code Year 02021 %2018 02015 DEverett School Dist DMukiltea School Dist <br /> Fire Sprinklers:DUpdate Existing[(New System IFINot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> - Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) • <br /> Fire Alarm: ❑Update Existing[(New System *lot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for perrriit? [(Yes Q1 No . <br /> Add!RCW 64.55 does required prior to final? DYes 1111No Additional Notes: <br /> VALUATION CALCULATION: Total$ 1 p 0700 <br /> Approved By: 4,,,,----2_../ Date: p3�1212d2' 1 <br /> PUBLIC • <br /> Intake OK by: Date: <br /> .....,.. <br /> • Intake Comments: tPWReview&Worksheet Needed i <br /> ,j DSys Dev Eval: <br /> Additional Notes: Artrp wtf ti ✓( �`,, JE DWater DSewer C�Storm <br /> �G1 <br /> tDTraffic Mitigation EvaI <br /> Approved By: Date: L f 4 �� IQSite Work/Drainage(shown/triggered) <br /> jClAddress Letter <br /> F1RI~ DEPARTMENT . IElBackflow Prevention for high hazard: <br /> `(dental,medical,animals,mortuary, <br /> Separate I Deferred Submittals Required: lhospitahi supportive housing) <br /> ElFire Sprinklers ❑Fire Alarm [(Other: <br /> Additional Notes: . Q 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 /> [(Minimal or No Fire Scope-NO FIRE FEE [( Is located In this folder <br /> [(Review/Inspection Scope-ADD FIRE FEE D Is In a Separate Green Folder(join With this foiderfor permit Issuance) <br /> Approved By: Date: . 0 Will be issued separately(Separate Green Folder,PW issued ahead ofeldg) <br /> Public Works has•no scope on this permit---PW Not Required <br /> ELECTR(CALIPLUMBING . Additional Notes: <br /> % • <br /> Additional Notes: <br /> Approved By: Date: Completed sy Date:4L/2+,'tp tt 4 <br />