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Intake&Approval Sheet III (FOR PERMIT STAFF ONLY) 0 PERMIT# 1 'c IOU 0. 1 <br /> BUILDING . PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> intake Comments: Intake Comments: <br /> Zone t110 <br /> ElMake this a"W"Permit ElSRC Required(Pre-Insp) Overlay/Agreement i 1 maltI Prate?edest7►an/ <br /> BIdg/Tl/Addn/Rem Size `11p3"3-- Nonresidential Use trootainrritnir rkrd 12eckral lor,-Gm C low <br /> Garage/Accessory Struct.Size .. Residential Use NI Ft <br /> Number of Stories I ~F A Proposed No.of Dwelling Units: 0 <br /> Basement C(No DYes, Fin I Unfin Total No.of Dwelling Units: WIN • <br /> Type of Construction I Planning/Landscape Inspection Required before Final? ❑Yes ENo <br /> Occupancy Group A 0 ,1!(11 �1 "In Lieu"Fee:Type: 95 Amount$ <br /> , <br /> Occupancy Load 1 School Impact Fee: Total $_ , <br /> Cent,of Occpuancy Required? ❑No u1Yes ❑Shell Only Calculated: 75 Credit: gr <br /> Code Year 02021 req-2018 E12015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers:DUpdate Existing lNew System DNet Req'd Park Impact Fees for permits applied for after 11112022: <br /> -• Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: 0 Update Existing ONew System Mot Req'd Fee Schedule Used For Calculation(Year): g <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? CIYes No <br /> Addl ROW 64.55 does required prior to final? EIYes No Additional Notes: <br /> VALUATION CALCULATION: Total$ 300M0 <br /> Approved By: i '- -- <br /> 7 Date: 02./206 2`/ <br /> PUBLIC WORKS 1 • <br /> Intake OK by: Date; <br /> • Intake Comments: PW Reviewif:-&Worksheet Needed w. <br /> • ,❑Sys Dev Eva!: <br /> OWater Clsewer ❑storm <br /> Additional Notes: <br /> ,DTraffic Mitigation Eval <br /> Approved Byl Date: /�� 1—lSife Work/Drainage(shown/triggered). l 11:Address Letter <br /> FIRE DEPACTiliOi ` DBackflow Prevention for high hazard: <br /> Separate 1 Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> phospital,supportive housing) <br /> Fire Sprinklers Fire Alarm ❑Other: I <br /> Additional Notes: • El This Permit is Approved by Public Works ' <br /> . El See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: Q A Separate PW Permit is Required(Permit#:PW ) <br /> El Review of As-Built Plans-NO FIRE FEE AND ❑Is fully digital <br /> LI Minimal or No Fire Scope-NO FIRE FEE d Is located In this folder <br /> St Review/inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder(loin with this folderfor permit lasuanca) <br /> Approved By; V,temexein Dated-,,ZQ-,..01, El Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> J Public Works has.no scope on this permit---PW Not Required <br /> ELEGTRICALIPLUMBING dditional Notes: <br /> • <br /> Additional Notes: ` <br /> Approved By: Date: Completed By: , lD/t Date: 7 /4( '4� 1 <br />