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k v icon Qf rev kc u 00()Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 24b5 — 0 I'a <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:J e 5 5 Date:B/?/Z L( <br /> Intake Comments: Intake Comments: <br /> Zone j„% 2 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement A IA r ACP1 <br /> Bldg/TI/Addn/Rem Size Nonresidential Use L. cenk nc.asitcic_\ Wareha.»e- <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories i Proposed No. of Dwelling Units: <br /> _Basement QNo Dyes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Occupancy Group u r = ( "In Lieu"Fee:Type: Amount$ C) <br /> Occupancy Load 7 School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? Io DYes DShell Only Calculated: Credit: <br /> Code Year 02021 02018. 1:12015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers:OUpdate Existing ❑New System El 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: QUpdate Existing New System Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: r��7 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes iLY.No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total$ )J3t U 0 <br /> w' cifitr6 Approved By: Date: 8/7/Z c.( <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> OSys Dev Eval: <br /> Additional Notes: OWater ❑Sewer ❑Storm <br /> I DTraffic Mitigation Eval <br /> Approved By: (c €31 Date: 7/,j /r hvl OSite Work/Drainage(shown/triggered) <br /> / D <br /> IAddress Letter <br /> FIRE DEPARTMENT I OBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> !hospital,supportive housing) <br /> -❑.Eire Sprinklers Fire Alarm DOther: <br /> Additional Notes: ❑ 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 /> *A--Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder coin with this folder for permit issuance) <br /> Approved By: V..Ne (AJ\ Date: 8_- 103. . ❑ 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 Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />