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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT#1(lI `QS- — V S 2-- <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 12-_( <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement PcIP, <br /> Bldg/TI/Addn/Rem Size Nonresidential Use i-411-\ <br /> Garage/Accessory Struct.Size , Residential Use S <br /> Number of Stories r-- Proposed No.of Dwelling Units: 0 <br /> Basement liNo DYes, Fin/Unfin Total No.of Dwelling Units: I <br /> Type of Construction ( Y -C Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group I et "In Lieu"Fee:Type: Q Amount$ C7 <br /> Occupancy Load I School Impact Fee: Total $ C3 <br /> Cert.of Occpuancy Required? lNo DYes ❑Shell Only Calculated: 0 Credit: X <br /> Code Year Zr2021 02018. 02015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'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: El Update Existing El New System SNot Req'd . Fee Schedule Used For Calculation(Year): <br /> ....................,..,.,,.,,......,....w.._, <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ' No Additional Notes: NO, <br /> VALUATION CALCULATION: Total$ cggR 6 <br /> Approved By: f - -- -. <br /> Date: 05130/2_0 z� <br /> 2g05 (37— %f-c) _ (NC° . <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: [PW Review&Worksheet Needed if: • <br /> 1❑Sys Dev Eval: <br /> OWater OSewer OStorm <br /> Additional Notes: I <br /> IDTraffic Mitigation Eval <br /> Approved B 4)Date: C> l'i�G y Oite Work/Drainage(shown/triggered) <br /> (] <br /> IAddress Letter <br /> FIRE DEPARTMENT fDBackflow Prevention for high hazard: <br /> ((dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: I <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 ❑ 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(join with this folder for permit issuance) <br /> Approved By: Date: ❑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 /> ELECTRICAL/PLUMBING ' . dditional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: ---of sox,D Date: [ZeL(z/JzLf <br />