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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) iftPERMIT# :2L1©.f-/q 2 <br /> BUILDING 1 NING <br /> ntake OK by: <br /> I 1Date: Intake OK by: Assign To:�t�w` Date: (0/��/ <br /> intake Comments: Intake Comments: <br /> Zone • <br /> -l . <br /> 0 Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement Kvdcu Om N&'1 4-Idkor,task, <br /> BidglTl/Addn/Rem Size ;Jfr Nonresidential Use <br /> Garage/Accessory Struct.Size kar Residential Use Its <br /> Number of Stories k/k • Proposed No.of Dwelling Units: . -to • <br /> Basement iiiNo Dyes, Pin 1 Unfin Total No.of Dwelling Units: I ' <br /> Type of Construction Z(u, PlanninglLandscape Inspection Required before Pinar? I:Yes ' No <br /> Occupancy Group ILL "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load E.( School Impact Fee: Total $.__ ' . <br /> Cert.of Occppancy Required? 141No Eyes }:Shell Only Calculated: , Credit: <br /> Cade Year )2021 02018 E12015 DEverett School Dist DMukllteo School Dist <br /> Fire Sprinklers:ElUpdate Existing ONew system JlNot Req'd Park Impact Fees for permits applied for after'i1112022: <br /> •-• Reason Sprinklers Required: Park impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: ElUpdate Existing❑New System iZINot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> ROW 64.55 MF worksheet req'd for permit? DYes El No , <br /> Add'I RCW.64.55 does required prior to final? ElYes END Additional Notes: -" 5`" "t- 0ck.nd-fir v4"4 <br /> VAI:UATION CALCULATION: Total$,__S b(u - r..w• BX4 tWAAw5 oaf 044e-• . <br /> Approved By: 1z,iu'/..-6 1 Date: (�/i//2 q <br /> PU] l IC WORKS . . <br /> Intake OK by: Date: <br /> , Intake Comments: FW Review&Worksheet Needed if: 1 Y4 <br /> 1[(Sys Dev Eval: <br /> Additional Notes: `' (( ❑Water ClSewer Clstorm <br /> QTraffic Mitigation Eve, <br /> Approved By: (_ K d6V Date: (,// C//Z0,Lat • JIJSite Work/Drainage(shown/triggered) , <br /> . l/ 6 t I QAddress Letter <br /> FNE'DEE'ACTM l IDBackflow Prevention for high hazard: <br /> • <br /> Separate/Deferred Submittals Req • [(dental, <br /> '(dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: . 0 This Permit Is Approved by Public Works • <br /> El See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: C(A Separate PW Permit is Required(Permit#:PW ) ' <br /> El Review of As-Built Plans-NO FIRE FEE AND 0 Is fully digital <br /> LI Minimal or No Fire Scope-NO FIRE FEE a Is located In this folder <br /> El Review/Inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder Uorn with this folderfor permit Issuance) <br /> Approved By: Date: . El Will be issued separately(separate Green Folder,PW issued ahead ofaldg) <br /> • ublic Works has.no scope on this permit--PW Not Required <br /> E>LEGTRICAL/FLUMInING . Additional Notes: . <br /> Additional Notes: <br /> Approved By: Date: Completed 13 _,_�`�-�.�''rate: Q¢`eLa J24 2-4- <br />