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• <br /> Intake&Approval Sheet (F ERMIT STAFF ONLY) PE # 3 c f C -O95 <br /> BUILDING . PLANNII <br /> intake OK by: Date: Intake OK by: Assign To: {7(T) Date:2. Ilan t 161.4 <br /> intake Comments: Intake Comments: <br /> Zone 2.•, <br /> 0 Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement • <br /> BIdg1Tl/Addn/Rem Size Re.AWt/i 1") Nonresidential Use <br /> Garage/Accessory Struct.Size l I Residential Use SR, <br /> , <br /> Number of Stories �/ • Proposed No.of Dwelling Units: . <br /> Basement ONo DYes, Fin 1 Unfin Total No.of Dwelling Units: 1 ' <br /> Type of Construction -LP C Planning/Landscape Inspection Required before Final? DYes IgNo <br /> Occupancy Group ( , "in Lieu"Fee:Type: Amount$ 0 IA <br /> Occupancy Load School Impact Fee: Total $ ' t4 IR , <br /> Cert.of Occpuancy Required? KNo DYes QShell Only Calculated: Credit: <br /> Code Year 02021i y2018ttt 02015'''''' QEverett School Dist ❑Mukllteo School Dist <br /> Fire Sprinklers:0Update Existing New System lNet Req'd Park Impact Fees for permits applied for after 11112022: <br /> _. Reason Sprinklers Required: Park impact Fee Total$ N 1 ft (net due after credit for existing uses) • <br /> Fire Alarm: ❑Update Existing ONew System ckNot Req'd Fee Schedule Used For Calculation(Year): M n V„un n <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes .No , <br /> Add'l RCW.64.55 docs required prior to final? DYes 1.410 Additional Notes: • <br /> VALUATION CALCULATION: Total$ 3 C ° • <br /> Approved By: tekvo Date: l2 ,tprtr1 p e'?4 <br /> PU4.1CVOliKS . . <br /> Intake OK by: Date; <br /> • Intake Comments: - IPW Review&Worksheet Needed if <br /> • ,1 DSys Dev Eval: <br /> • <br /> Additional Notes: 1 ❑Water LISewer C(Storm <br /> (OTraffic Mitigation Eval, <br /> !Approved By: Date: (21'')41C(Site Work/Drainage(shown/triggered) <br /> • IClAddress Letter <br /> • Fikg DEPARTMENT IDBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> I Deferred Submittals Required: ` <br /> 'hospital,supportive housing) <br /> !_!Fire Sprinklers ❑Fire Alarm DOther: i <br /> Additional Notes: . Q 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 /> O Review of As-Built Plans..NO FIRE FEE AND Q Is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> O Review/inspection Scope-ADD FIRE FEE CI Is in a Separate Green Folder(iornwith this folder for permit Issuance) <br /> Approved By: Date: . 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> gj Public Works has•no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING • Additional Notes: <br /> • <br /> Additional Notes: ` <br /> Approved By: Date: Completed By: A)r 75ry ie_Date: n 3-/5'..7`f <br />