|
Intake&Approval Sheet (1.PERMIT STAFF ONLY) P T# ��`C Q3-0 0
<br /> BUILDING . PLANNING
<br /> intake OK by: Date: Intake OK by: Assign To:.
<br /> — bate: 31j/
<br /> Intake Comments: intake Comments:
<br /> Zone 13 .
<br /> 0 Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement • ,I,
<br /> BldglTllAddn/Rem Size Nonresidential Use VS
<br /> Garage/Accessory Struct.Size Residential Use
<br /> Number of Stories Proposed No.of Dwelling Units: 0 .
<br /> Basement DNo DYe Pin/Unfin Total No.of Dwelling Units: 0 •
<br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes No
<br /> Occupancy Group "in`Lieu"Fee:Type: Amount$
<br /> Occupancy Load L School Impact Fee: Total $
<br /> Cent,of Occppancy Req u . a No dOnly ,Yes UShell Calculated: Credit:
<br /> r d�
<br /> Code Year 02021 02018 02015 DEverett School Dist DMukllteo School Dist
<br /> Fire Sprinklers:DUpda Existing Mew System CONat Req'd Park Impact Fees for permits applied for after 11112022:
<br /> 1 -• Reason Sprinklers --quired: Park impact Fee Total$ (net due after credit for ex/sting uses) •
<br /> Existing❑New System UNot Req'd Fee Schedule Used For Cal c{ilation(Year):
<br /> Fire Alarm: pdate Y q u ..,. _....,-...,_ .,,.., ,.,,,.,..,,, ,,,,,,,,,,,�„ „�„,., ,,,, ,.w.m.,,,.,,.
<br /> Reason Fire ' -rm Required: XI /OTia c k d (G✓tc7� :1J"- fa he ��C�i�t cr_
<br /> RCW 64.55 worksheet req'd for perrriit? DYes 0 No yki-1 .f'hk,(a1 Fa No gat ov?A aksl j 4 r ca nf},.,,,h,i
<br /> Add'I R • .64.55 docs required prior to final? DYes QNo Additional Notes: SI4.-01 o rd I as ufr6k-il art I 716°1 S
<br /> VALUA ION CALCULATION: Total$ 7; ®
<br /> Approved By: 1. Date: 3/(/2 y
<br /> . PUBLIC '
<br /> Intake OK by: Date:-..,,a,,,u..,,,,.n .W....--V,,,.,,,..1.,. 1,.,.,.,,- ...-,w.
<br /> • Intake Comments: - 1131Review&Worksheet Needed if
<br /> • ,IDSys Dev Eval:
<br /> Additional Notes: / i, ?OSi( QWafer I�Sewer ❑Storm
<br /> Lam! T/�l ,,DTraffic Mitigation Eva!,
<br /> E
<br /> Approved By: Date: inSite Work/Drainage(shown/triggered)
<br /> . jDAddress Letter
<br /> PIIBB DBPARMTNT ;DBackflow Prevention for high hazard:
<br /> [(dental,medical,animals,mortuary,
<br /> Separate I Deferred Submittals Required: hospital,supportive housing)
<br /> DFire Sprinklers ElFire Alarm ❑Other: i
<br /> Additional Notes: . 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 /> El Review of As-Built Plans-NO FIRE FEE AND Q is fully digital
<br /> Minimal or No Fire Scope-NO FiRE FEE 0 Is located in this folder
<br /> El Review/inspection Scope-ADD FIRE FEE 0 is in a Separate Green Folder Uoln with this folderforpermit Issuance)
<br /> Approved By: NK,Vx--c, A Date: 2 .-2!/ 0 Will he issued separately(Separate Green Folder,PW issued ahead of Bldg)
<br /> 0 Public Works has•no scope on this permit--PW Not Required
<br /> )~LI~GTRICALIPLUNIBING • Additional Notes:
<br /> •
<br /> Additional Notes: `
<br /> Approved By: Date: Completed Sy:1`' Ssii14 Date: -j/64/242...Lt
<br />
|