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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# rfa (14 7-oa s <br /> BUILDING DINING <br /> Intake OK by: Date: Intake OK by: Assign To: ii'^"1'` Date: -i(`(/24f <br /> intake Comments: intake Comments: <br /> Zone `j�— . <br /> ❑Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessary Struct.Size Residential Use - 1—TZ_ <br /> Number of Stories I t • Proposed No.of Dwelling Units: . <br /> Basement ti/No DYes, Fin/Unfin Total No.of Dwelling.Units: ' <br /> Type of Construction X$•(1. Planning/Landscape Inspection Required before Mal? DYes, tt.o <br /> Occupancy Group X-iZ{1 • "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load •-EP1.•. . School Impact Fee; Total $ ai fr. ' , <br /> Cert.of Occpuancy Required? V{No EIYes DShell Only Calculated: , Credit: <br /> Code Year V51202-I 02018 E12015 DEverett School Dist DIMukilteo School Dist <br /> Fire Sprinklers:DUpdate Existing❑New System (ot Req'd Park Impact Fees for permits applied for after'i1112022: <br /> Reason Sprinklers Required: Park impact Fee Total$ " /Gc- (net due after credit far existing uses) <br /> Fire Alarm: ElUpdate Existing El New System HNot Req'd Fee Schedule Used For calculation(Year): <br /> Reason Fire Alarm Required: <br /> ROW 64.55 MF worksheet req'd for perrriit? ayes No �''i-..-i" e- `'I= cs"Ly <br /> Add!ROW.64.55 does required prior to final? Mee KNo Additional Notes: <br /> VA[:UA'TION CALCULATION: Total$ 1 t goo <br /> Approved By: Z-------Aate: '7 6-) (202.-cl <br /> . PUB.LlC WORKS • • <br /> Intake OK by: Date: ' <br /> • Intake Comments: PW Review&Worksheet Needed if• <br /> • ) ,IdSys Dev Eval: <br /> Additional Notes: OWater DSewer ClStorm <br /> DITraffic Mitigation Eva!, <br /> Approved By: �•�o4 .�Date: $111 EI�Site Work/Drainage(shown/triggered)• Il_lAddress Letter <br /> Elk,'DEPARTM NT' jflBaokflow Prevention for high hazard; <br /> Separate/Deferred Submittals Required: ((dental, animals,ui mortuary, <br /> �hospial(tal,supportive housing) <br /> Fire Sprinklers EIFire Alarm Daher: <br /> Additional Notes: . D This Permit is Approved by Public Works • <br /> . 0 See PW Review Worksheet and associated attached items <br /> Fire Dept Fees: El A Separate PW Permit is Required(Permit#:PW ) <br /> El Review of As-Built Plans-NO FIRE FEE AND ❑Is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE El Is located in this folder <br /> El Review/Inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder(loin with this folderfor permit Issuance) <br /> Approved By: Date: J El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ►i1 Public Worgs has•no scope on this permit---PW Not Required <br /> ELEGT.RICAL/PLUMBING [editfonal Notes: <br /> • <br /> Additional Notes: ` <br /> Approved By: Date: Completed Byri Date: -7 h/' <br />