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Intake &Approval Sheet (Fr" PERMIT STAFF ONLY) PERMIT# eg-P—L{, 03 ' (311
<br /> BUILDING . PLANN,
<br /> intake OK by: Date: Intake OK by: Assign To: Date:
<br /> intake Comments: Intake Comments:
<br /> _ Zone 41 lam/
<br /> 0 Make this a"W"Permit ❑SRC Required(Pre-Inep Overlay/Agreement
<br /> U1dg/Tl/Addn/Rem Size Nonresidential Use
<br /> Garage/Accessory Struct.Size Residential Use —
<br /> Number of Stories Proposed No.of Dwelling Units: . ^_
<br /> Basement ❑No t r? Fin/Unfin Total No.of Dwelling Units: — '
<br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ONO '
<br /> Occupancy Group ild "in Lieu"Fee:Type: Amount$
<br /> Occupancy Load School Impact Fee: Total $ ,
<br /> pert. of Occpuancy Required? ■'10 DYes DShell Only Calculated: Credit:
<br /> Code Year •2021 02018 D12015 DEverett School Dist DMukllteo School Dist
<br /> Fire Sprinklers: DUpdate Exi ng DNew System El Not Req'd Park Impact Fees for permits applied for after 11112022:
<br /> ,Reason Sprinklers Require,: Park impact Fee Total$ ' (net due after credit for existing uses)
<br /> Fire Alarm: ❑Update xisting❑New System :Not Req'd Fee Schedule Used For Calculation(Year):
<br /> Reason Fire Alarm Required: .,,..,,,/,,,,e.i— ,,.,,_/t//-`; ,-,,,.S.,,,`1', L .,/ ,,,, .`,,,..,.,,/,9/.,a,,,,._A,c„ ,,.,,.,,,,
<br /> ROW 64.55 MF worksheet req'd for perniit7 DYes 11 No o/��LC�, — of.,.4d e` es% — ,
<br /> Add'I ROW 64.55 does required prior to final? Dyes JNo Additional Notes: / ,41,"
<br /> VALUATION CALCULATION: Total$
<br /> Approved By: —Date: 3 7J'- 7`/
<br /> PUBLICWORKS .
<br /> Intake OK by: Date:
<br /> Intake Comments: jPWRevietiv&WorksheefNeededif.I'M 11Y 1
<br /> • , I_Isys Dev Eva!:
<br /> Additional Notes: DWater DSewer ❑Storm
<br /> A um) f CDTraffic Mitigation Eva!,
<br /> Approved By: Lam' Date: 3 Js--`'( Mite Work/Drainage(shownitri'ggered)
<br /> • jfAddress Letter
<br /> . t
<br /> F[RE'DEPAI3TMENT =Deacktlow Prevention for high hazard:
<br /> •Separate I Deferred Submittals Required: I(dental,medical,animals,mortuary,
<br /> !hospital,supportive housing)
<br /> El Fire Sprinklers ❑Fire Alarm ❑Other: 1
<br /> Additional Notes: ❑This Permit is Approved by Public Works '
<br /> . 0 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 ❑Is fully digital
<br /> Minimal or No Fire Scope-NO FIRE FEE 0 Is located fn this folder
<br /> EI Review/inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder(join with this folder for permit issuance)
<br /> Approved By:K tcoe,,t)n Date: �',i�'--'la 0 Will be issued separately(Separate Green Folder,PW issued ahead F4siublic Works has.no scope on this permit---PW Not Required
<br /> DLI~GTRICAL/1?LUMI3ING Additional Notes:
<br /> Additional Notes:
<br /> Approved By: Date: Completed By jL, _/7°. ' Date: 3/Ze_.)j2‘L 1
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