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—/1,StOt3S Arrea. 6-PPP.a/ �o <br /> Intake &Approval Sheet (( PERMIT STAFF ONLY) P T Oqi <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone "VS <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size (` -Z"? _ Nonresidential Use <br /> Garage/Accessory Struct.Size I--' I I Residential Use Y <br /> Number of Stories <3 Proposed No.of Dwelling Units: ( <br /> Basement pia DYes, Fin/Unfin Total No.of Dwelling Units: / <br /> Type of Construction 1 f-C Planning/Landscape Inspection Required before Final? ;es ❑No <br /> Occupancy Group \R--C "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load S K-C _ School Impact Fee: Total $ /��yG — <br /> Cert. of Occpuancy Required? ❑No EYes ❑Shell Only Calculated: 4 i w Credit: -(— <br /> Code Year ❑, 0 1 J2 2018 02015 DEverett School Dist ulukilteo School Dist <br /> L�1 Fire Sprinklers: DUpdate Existing New System ❑Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: el-0 Park Impact Fee Total$ 2.337 (net duen after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System of Req'd Fee Schedule Used For Calculation(Year): tX U G <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes rd No /� <br /> Add'I RCW.64.55 docs required prior to final? ❑Yes NI No Additional Notes: / J''"/ (..° At-i, <br /> VALUATION CALCULATION: Total$ i _A$; <br /> t 7A7 ;(-- 16.6 '" oP. 'mi , J <br /> 61 - Approved By: � Date: il'-G 2 <br /> l <br /> x 6(4 — 0 al �so(f PUBLICtWORKS <br /> 6 t-{ — o2- 0 r Intake OK by: Date: <br /> 0. Intake Comments: IPW Review&Worksheet Needed if: <br /> gtS O?Q (DSys Dev Eval: <br /> t ❑Water OSewer ❑Storm <br /> Additional Notes: <br /> \('�J IOTraffic Mitigation Eval <br /> Approved By��il Date: (2/Z(/2 OSife Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT luBackflow Prevention for high hazard: <br /> •Separate/Deferred Submittals Required: !hospital, <br /> ,medical,r animals,mortuary, <br /> p q �hospifal,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: l <br /> Additional Notes: Di This Permit is Approved by Public Works <br /> . ❑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 /> ❑ 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(loin with this folder for permit issuance) <br /> Approved By: ,, _cowl Date: )2-/E3 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: <br /> • ,J Additional Notes: S T i I�1 �Lr tM <br /> Approved By: Date: Completed By:4jL1,_, ity c i Date: 1211'b J Lb2 <br />