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0 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# '✓)S is - <br /> /( <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:_ Date: <br /> Intake Comments: Intake Comments: <br /> Zone _ <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size '' (V Nonresidential Use /y <br /> `t� <br /> Garage/Accessory Struct. Size 1(} Residential Use y <br /> Number of Stories Proposed No.of Dwelling Units: _ ( <br /> Basement DANo ❑Yes , Fin/Unfin Total No. of Dwelling Units: / <br /> Type of Construction 14/1 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? ❑No Yes ❑ Z Shell Only Calculated: /� / Credit: <br /> Code Year 02021 1562018 02015 DEverett School Dist , vlukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System L4Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 3.-7 J/ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year):_ ,2 v 2- <br /> Reason Fire Alarm Required: ��--t� <br /> RCW 64.55 MF worksheet req'd for permit? ❑ 11LY Yes .No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes [SINo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> 7( 1 I .= Approved By:pi AL------ c" —.-----bate: �.-/c% - "2, _ <br /> 4 (IV U> " '>2 34,0 PUBLIC WORKS <br /> Intake OK by: Date: <br /> ,-) Intake Comments: i PW Review&Worksheet Needed if: <br /> IEISys Dev Eval: <br /> ,�p��--__ �ov`t--/I- -�� -'r /2 O�—0 S< <br /> Additional Notes: ' f / ❑Water ❑Sewer YJ Storm <br /> w ., r � 1 <br /> i ��i t4 w.Z111"4_ ❑Traffic Mitigation Eval <br /> Approved By: j ,� Date: it )'l)j 1'/ I Site Work/Drainage(shown/triggered) <br /> V' DAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,p animals,mortuary, <br /> hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: laThis Permit is Approved by Public Works <br /> ,5 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ® ASeparate PW Permit is Required.,Permit#: PW1 1/,7y'-0 j-S ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 91 Is fully digital <br /> Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:K t Q)Co w(\ Date: j j.. i.);, ID 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 /> Additional Notes: l <br /> Approved By: Date: Completed By: /I�i7 -�b r1.iY,_ Date: of ._ 2t, _2_0],' <br />