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kvi5 n/J S A i7 z fre(4;vki Intake &Approval Sheet (I• ' PERMIT STAFF ONLY) T# t0A304" OY(TG <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone �1//3 <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size U9 21- Nonresidential Use / <br /> Garage/Accessory Struct.Size 911 Residential Use <br /> Number of Stories -3 Proposed No.of Dwelling Units: I <br /> Basement VINo ❑Yes, Fin/Unfin Total No.of Dwelling Units: ' <br /> Type of Construction 1 ' - Planning/Landscape Inspection Required before Final? Yes ❑No <br /> "In Lieu"Fee:Type: ------ Amount$ <br /> Occupancy Group \ YP L/ <br /> Occupancy Load \ RC, School Impact Fee: Total $ /// j7V' <br /> Cert.of Occpuancy Required? ❑No KYes ❑Shell Only Calculated: ,/ 0/io Credit: -6) <br /> Code Year ❑20 1 42018 1:12015 DEverett School Dist CaMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing LYINew System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: 10 Sk V t J1T5 Park Impact Fee Total$ 51J/ (net due after cred�for existing uses) <br /> Fire Alarm: DUpdate Existing❑New System ,,Not Req'd Fee Schedule Used For Calculation(Year): Z <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes l No <br /> Add!RCW 64.55 does required prior to final? ❑Yes Et No Additional Notes: e///ems/ , 71 Jk,-hwy Q <br /> VALUATION CALCULATION: Total$ 3 2 ►�!� d/#1,A- <br /> t-7 7 � ( 6 C� Tr4 6E� Approved By: Date: t Il',Z/ <br /> `'f ( x 614 — c7 6't 3oLf PUBLIC WORKS <br /> 3 v< >4- 6 (4 Og? Intake OK by: Date: <br /> Intake Comments: IPW Review&Worksheet Needed if: <br /> li2 t C'/ ( �!_j; '❑Sys Dev Eval: <br /> Additional Notes: ❑Water OSewer ❑Storm <br /> ICDTrafc Mitigation Eval <br /> Approved By: !V\ Date: (# (it 72_5 IC1Site Work/Drainage(shownitriggered) <br /> II:Address Letter <br /> FIRE DEPARTMENT tDDBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,pr animals,mortuary, <br /> p q hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: RI This Permit is Approved by Public Works <br /> . 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑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 ❑ Is located in this folder <br /> fil Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this foiderfor permit issuance) <br /> Approved By: , 2), in Date:tQ_-faj ....:23 ❑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: RO 1% 'yf `VW 410v1 <br /> Approved By: Date: Completed By: , 1, Vf''All ate: L7/I i 3 IZO 2. <br />