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/ntaKe cfcRppFOVa/ (t`tat1 I'",CJ IIII.II I/4t • UIVLY) PERIVIIT# 40,63,?O 41r o5'I <br /> BUILDING • ,/� *INNING <br /> intake OK by: Date: intake OK by:% 7: Assign To:J CSS Date:5/iZ/Z3 <br /> intake Comments: Intake Comm Yi' <br /> Zone R_2 <br /> Overlay/Agreement Slclewallc prtor�}� <br /> Q Route to Commercial Building Nonresidential Use ►.1/A <br /> ❑ Route to Residential Building Residential Use 5 F R. <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: -- <br /> BIdg/TI/Add Rem Siz /'2O)( S ci y S P- Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? DYes ONo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement gNo ['Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction 1 .. Calculated: Credit: <br /> Occupancy Group QJ DEverett School Dist i hlukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after'i/112022: <br /> Fire Sprinklers: DUpdate Existing ONew System Jallot Req'd Park impact Fee Total$ 0 (net due after credit for existing uses) <br /> Reason Sprinklers Required: qq--�� Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ,last Update Existing [New System Not Req'd Permit Technician Use Only:Apply Phase-in Credit Per EIVICI9.53.200 <br /> Reason Fire Alarm Required: Q 100%Credit Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? Dyes N1No ID 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'1 RCW 64.55 does required prior to final? DYes Io ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 600 Additional Notes: <br /> Approved By; Date: 5/12 /2,3 <br /> • <br /> PUBLIC WORKS • . . . <br /> Additional Notes: ex POSE A- _ 00E(2i O Intake OK by: Date: <br /> (2-14- '-0(2- I NNSPEC.3.70 N i Intake Comments: PW Worksheet Needed If: <br /> ❑Sys Dev Eval(UtillsW)1_ITraffic Mit Eval <br /> Approved By: ig-P{-4 Date: 5/3/240 3 DSite Work/Drainage DAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> • (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT • supportive housing) <br /> Separate/Deferred Submittals Required: DRoute this folder for PW Review at end --PW Review Worksheet <br /> El Fire Sprinklers ❑Fire Alarm DOther: DThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND EiCreate Green Folder OSubmitted Previously ❑Deferred <br /> El This Permit is Approved by Public Works <br /> Fire Dept Fees: 0 See PW Review Worksheet and associated attached items <br /> El Review of As-Built Pians-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#: PW <br /> El Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> 0 Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folderfor permit Issuance) <br /> Approved By: Date: CI Wili be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> gPublic Works has no scope--PW Not Required <br /> ELECTRICAL/KVA/1BING Additional Notes: <br /> Additional Notes: /z. z.r <br /> Approved By: Date: Completed lay"." -Ze Date: 6,5 <br />