Laserfiche WebLink
Intake&Approval Sheet (FOR PERMIT STAFF ONLY) pRMIT#-Le07 4c9 7 <br /> BUILDING . —INING <br /> Intake OK by: pate: Intake OK by: Assign To: V(a Date: a Av0 U <br /> intake Comments: intake Comments: <br /> Zone 12.•Z <br /> ❑Make this a"W"Permit ❑SRC Requlred(Pro-Inep) Overlay/Agreement CowtYa4 Qc taw t 4191111111111 <br /> 131d ddn/Rem Size 74 O 9 r Nonresidential Use gatki M, <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: . <br /> Basement ElNo 09, Fin 1 Lint' Total No.of Dwelling Units: ' <br /> Type of Construction PlanninglLandscape Inspection Required before Final? DYes 1SiiNo <br /> Occupancy Group / "In Lieu"Fee:Type: Amount$ will <br /> ll <br /> Occupancy Load /.J School Impact Fee: Total $ 4 I Pr , <br /> Cert.of Occpuancy Required? ,Io bYes EIShell Only Calculated: Credit: <br /> Code Year E12021 02018 0(2015 DEverett School Dist DMuklltea School Dist <br /> Fire Sprinklers:MUpdate Existing CINew System Mat Req'd Park Impact Fees for permits applied for after 11112022: <br /> - Reason Sprinklers Required: f f.Yx7 WO/0 lota`L^— Park impact Fee Total$ 'N I' (net due after credit farexxfsting uses) • <br /> Fire Alarm: FIDpdate Existing ONew System Mot Req'd Fee Schedule,Used For Calculation(\'ear), N^n Nu�nnV„p^4 N„ <br /> Reason Fire Alarm Required: NW Val (°0W��- <br /> ROW 64.55 MF worksheet req'd for permit? DYes 0 No , <br /> Add'I ROW.64.55 dace required prior to final? ElYeS DNo Additional Notes: • <br /> VALUATION CALCULATION: Total$,4-9 D yIOd . <br /> Approved By: c4• Date: a Av51,5 f <br /> . PUi31-IC WORKS . , . . <br /> Intake OK by: Date: <br /> • Intake Comments: PW Review&Worksheef Needed if•�....,., <br /> ' ; 1 DSys Dev Eval: <br /> Additional Notes: • I DWater ElSewer Ostorm <br /> IDTraffic Mitigation Evval, <br /> !Approved By: Date: 9'( ( /)•$ Clsite Work/Drainage(shownitrtggered) <br /> • IQAddress Letter <br /> FIRE'DI~PARTI1/1 IIIT 'ElBacktlow Prevention for high hazard: <br /> Separate I Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> p q hosp(tal,supportive housing) <br /> ,Eire Sprinklers 'i ire Alarm DOther: I <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: El A Separate PW Permit is Required(Permit)#:PW ) • <br /> LI Review of As-Built Plans_NO FIRE FEE AND Q Is fully digital <br /> Ell Minimal or No Fire Scope-NO FIRE FEE El Is located in this folder <br /> sga Review/inspection Scope-ADD FIRE FEE 0 is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:Ik<krt--0 Date:g; .24/ / El Will be issued separately(Separate Green Folder,PW issued ahead ofaldg) <br /> ,4. •ublic Works has.no scope on this permit---PW Not Required <br /> . E,LEGTRICAL/PLUMBING . 'additional Notes: <br /> • <br /> Additional Notes: ` <br /> Approved By: Date: Completed By: VQ Date: 1 (eyirii)s' <br />