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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 15 -Lfo 1 —/57 <br /> BUILDING . 1 .NiNG /J <br /> Intake OK by: pate: h/ I intake OK by: Assign To;.►1 (e$' Date: _l/2/VI <br /> Intake Comments: l Intake Comments: <br /> Zone 'E-7.--- _ <br /> 0 Make thle a"W"Permit ❑SRC Required(Pra-Inip) Overlay/Agreement • <br /> BIdgiTl/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct. Size fV 2/..W % Residential Use Sf-Z. — Jet'Alecl 1 <br /> Number of Stories Proposed No.of Dwelling Units: . t I'/a �J <br /> Basement Igl•No [(Yes, Fin/Unfin Total No.of Dwelling Units: 1 ' _ <br /> Type of Construction V Planning/Landscape Inspection Required before Final? ❑Yes lNo <br /> Occupancy Group L) "In Lieu"Fee:Type: in 1a Amount$ <br /> Occupancy Load + School Impact Fee: Total $ vl k , <br /> Cert.of Occpuancy Required? CDNo IYes UShell Only Calculated: Credit: <br /> Code Year rir,1021 1 12018 02015 DEverett School Dist ❑Mukllteo School Dist <br /> Fire Sprinklers:El Update Existing ONew System !Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> - Reason Sprinklers Required: Park impact Fee Total$ f'H (net due after credit for existing uses) <br /> Fire Alarm: D Update Existing El New System KNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> ROW 64.55 MP worksheet req'd for permit? QYes r�No 1 <br /> Add'I ROW.64.55 duos required prior to final? OYes 121No Additional Notes: e.�L,N s. 4 d <br /> e.p o C ,i-mc wee <br /> VALUATION CALCULATION: Total$ �G.e 1 CJ'� <br /> Approved By: - Date: L /512 I <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> • Intake Comments: PWiZeview&Worksheet Needed if: <br /> • ��t " x\'V : 2ti2>� <br /> � , V5ysDevEvai:• <br /> Additional Netes: ) :Water DSewer I Storm <br /> r p/ �9 <br /> - 1 i + l]Traffic Mitigation Eva!, <br /> 5 d di , <br /> 'Approved By; te; 1 S I l a -- IQSite Work/Drainage(shown/triggered) <br /> • ok•GWviS f IDAddress Letter <br /> FIR)~'DI;i'AE2TMI NT d,i y S 1 ova' I Mackflow Prevention for high hazard: <br /> • <br /> Separate/Deferred Submittals Required: o (denial,medical,animals,mortuary, <br /> q hospital,supportive housing) <br /> ❑Fire Sprinklers DFire Alarm QOther: YlOt het Yl <br /> Additional Notes: This Permit Is Approved by Public Works • <br /> ]$1 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#:PW ) • <br /> C1 Review of As-Built Plans-NO FIRE FEE AND C1 Is fully digital <br /> g Minimal or No Fire Scope-NO FIRE FEE E Is located in this folder <br /> Ely 1 Review/Inspection Scope-AD❑FIRE FEE Is in a Separate Green Folder(join with this atderfbr permit Issuance) <br /> Approved By: ( <?� Date; 1-/-�c2 y 0 Will be issued separately(Separate Green Folder,?W issued ahead of51dg) <br /> 0 Public Works has•no scope on this permit---PW Not Required <br /> ELECTRICAL/1?LUMBIIVG Additional Notes: <br /> Additional Notes: <br /> Approved By; Date: Completed Eiy:jouvvte. kyhay� Date: 641161-22)2,11 <br />