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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# g 2 140 ( 0 7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 1 Y I v <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/AddnlRem Size Nonresidential Use )j C -hco <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No DYes, Fin!Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ / <br /> Cert.ofOccpuancyRequired? KCNo DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 li12018 02015 DEverett School Dist ❑Mukiiteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System lNot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing DNew System Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ®No <br /> Add'I RCW 64.55 does required prior to final? DYes ®No Add'I'3t\71( QQ <br /> aotes: 1 <br /> VALUATION CALCULATION: Total$ 0f s-pp n 1 2 i I /Z <br /> Approved By: Date:/ -/ <br /> �/ <br /> PUBLIC WORKS • . <br /> Intake OK by: Date; <br /> Intake Comments: PW Review&Worksheet Needed it': <br /> .f DSys Dev Eval: <br /> ❑Water Mower DStorm <br /> Additional Notes: iew/h Vipk, <br /> I DTraffic Mitigation Eval <br /> Approved By: (A{ ya.a,., Date: .i�I ),h DSite Work/Drainage(shown/triggered) <br /> I <br /> I DAddress Letter <br /> FIRE DEPARTMENT IDBackflow Prevention for high hazard: <br /> Separate!Deferred Submittals Required: ( <br /> (dental,medical,animals,mortuary, <br /> supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: 0 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 /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> ❑Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: .�p(,v,0 Date: 1 }-2u 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> yl Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed By: i( �. <br /> /�7�J e�,�. Date: eV 1 f 1,D 7_y <br />