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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1'o2--(--t©i O co <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone '(YI V <br /> ❑Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use (2jy Ul cy‘ <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? 1ZINo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 E12018 02015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System KNot Req'd Park Impact Fees for perms 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 FNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for permit? ❑Yes 4 No <br /> Add'I RCW.64.55 does required prior to final? ❑Yes IKINo Additional Notes: An <br /> /zq <br /> VALUATION CALCULATION: Total$ (7 I y � t r�fl . -/I ppr�: Date: <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if. <br /> • ❑Sys Dev Eval: <br /> Additional Notes: ,V_/ D ti�� ❑Water OSewer ❑Storm <br /> IfL QTraf is Mitigation Eval <br /> Approved By: U. L�tNs, ,,,,, Date: ;_(f I ZH IDSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT 1DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental, smupportive <br /> animals,mortuary, <br /> p q ,hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: i <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 ❑ Is fully digital <br /> IFI-Minimal or No Fire Scope-NO FIRE FEE 0 Is located In this folder <br /> ❑Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By \ 4.-ir\ Date: 1^3/)-2,21 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> cz 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: , 7-_„ at <br /> Date: 011 3 i/. _-/ <br />