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Intake&Approval Sheet -tFOR PERMIT STAFF ONLY) HERMIT# 301 L.(((c 0116 <br /> BUILDiNG . PLANNING <br /> Intake 0K by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement • <br /> BldglTl/Addn/Rem Size g g1 Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories t Proposed No.of Dwelling Units: . <br /> Basement INo 0Yes, Fin/Unfin Total No.of Dwelling Units: ' <br /> Type of Construction V Irj Planning/Landscape Inspection Required before Final? CIYes UNo ' <br /> Occupancy Group ' "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load t-t School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ONo tYes 111Shell Only Calculated: Credit: <br /> Code Year 02021 142018 02015 DEverett School Dist ❑Mukiiteo School Dist <br /> Fire Sprinklers:DUpdate 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 forexisftng uses) • <br /> Fire Alarm: ❑Update Existing FNew System DNot Req'd Fee SchedulelUsed For Calculation(Year); M <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for permit? DYes142,i No <br /> Add'I RCW.64.55 dons required prior to final? IJYes KNo Additional Notes: <br /> VALUATION CALCULATION: Total . <br /> Approved By: 4 Date: l ley <br /> (&in‘)(3)) -11 VA <br /> , PUB.LICWOR <br /> ` KS <br /> Cc 6(5. -'tt.. 1 f Intake OK by: f I Date: ® / 2417402,4.,w,.....,,.,.. <br /> Intake Comments: PWReview&Worksheet Needed If: <br /> • <br /> CO <br /> _) fled Arm ,I0Sys Dev Eval: <br /> Additional Notes: /� (/j�{J l (J �f,/ DWater aSewer'Storm <br /> nc-- p � � � ! ' � � �vI I <br /> Cc DTraffic Mitigation Eval <br /> p <br /> Approved By: .� (��c„� Date: �1�I� d i�Pvper/ <br /> ' "d Ott S f�Sife Work/Drainage(shown/triggered) <br /> • ll /WO �;�� w®�c IQAddress Letter <br /> FIRE DEE'ARTMEN ID5ackflow Prevention for high hazard: <br /> pre DS <br /> Separate Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> p q �� �r, [hospital,supportive housing) <br /> Fire Sprinklers 18t ire Alarm ❑Other: u i <br /> Additional Notes: tifThis Permit Is Approved by Public Works • <br /> . See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#:PW ) • <br /> 0 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(fob wIth this folderfor permit issuance) <br /> Approved By' V., , Cr(AJ\ Date:L-26-24 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has.no scope on this permit---PW Not Required <br /> • E,LEGT.RiCAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed B % I, Date: o2424l0� <br /> 1 . <br />