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Intake &Approval Sheet (10 PERMIT STAFF ONLY) PI"# C0 <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by:,e , Assign To:J&, .c Date: Z-/Z(0/aq <br /> intake Comments: Intake Comments: <br /> Zone L.-T.2.. . <br /> Q Maka this a"W"Permit ❑SRC Required(Fre•lnsp) Overlay/Agreement A\✓a k AL Pr <br /> I:3ldg1TI/AddnlRem Size -.Al * Nonresidential Use Licy-tgr Indvsfriu S <br /> Garage/Accessory Struot. Size Residential Use '— <br /> Number of Stories Proposed No.of Dwelling Units: — <br /> • <br /> Basement 1L1No ElYes, Fin 1 Unfln Total No.of Dwelling Units: " ' <br /> Type of Construction q Planning/Landscape Inspection Required before Final? C(Yes 1No <br /> Occupancy Group C (.4 , "in Lieu"Fee:Type: Amount$ 0 <br /> Occupancy Load r School impact Fee: Total $ U <br /> Cert.of Occpuancy Required? fiNo LIYe5 EIShell Only Calculated: Credit: <br /> Code Year 02021 ii12018 E12015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers: Update Existing❑New System tNietReq`d- Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total 0 net due after credit for existing uses) <br /> Fire Alarm: 13Update Existing 0 New System r'Iteq'd Fee Schedule Used For Calculation(Year):m N--41ry A4 y g M„w * F <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for perrriit? DYes El No <br /> Add!RCW 64.55 does required prior to final? DYES LENo Additional Notes: <br /> VALUATION CALCULATION: Total$, i ot) , <br /> Approved By.� Date:2/2(o/2c{ <br /> PUBLIC WORKS . , . <br /> Intake OK by: Date: _ _ _ <br /> • Intake Comments: PW Review&Worksheet Needed lf: <br /> • _ , ❑Sys Day Eval: <br /> DWater brewer DStorm <br /> Additional Notes: ' <br /> ❑Traffic Mitigation Eval <br /> Approved By: r e„), ,,,9„, Date:73/j1 I).Li , ❑Site Work/Drainage(shown/triggered) , <br /> )Address Letter <br /> Fil DEIaARTME JT i1I3ackflow Prevention for high hazard: <br /> •Separate/Deferred Submittals Required: (dental, supportivemedii animals,mortuary, <br /> ��.__`` hospital, housing) <br /> ait=lre.Sprinklers ElFire Alarm DOther: • <br /> Additional Notes: Q This Permit is Approved by Public Works • <br /> 0 Sea PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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 El Is located in this folder <br /> - Review/Inspection Scope••ADD FiRE FEE 00 Is in a Separate Green Folder(loin with thrs folder far permit Issuance) <br /> Approved By: 1< t d(,�/, Date: ,z JQ. El Will be issued separately(Separate Green Folder,PW issued ahead of Skip) <br /> YPublic Works has.no scope on this permit••-••PW tot Required _ <br /> ___ <br /> 81..1~GTRICAL/PLUMBING . Additional Notes: <br /> ‘ • <br /> Additional Notes: <br /> Approved By: Date: Completed By: " ( 'y„ Date: •,.��Ili /2• <br />