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i<' •-• ii‘ 6'I°AC- fi----k (i-eft<Ourci-L-D ,-) <br /> Intake &Approval Sheet PERMIT STAFF ONLY) m ilT# 3o <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone �c e <br /> ❑Make this a"W"Permit 0 SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size 12-' Nonresidential Use <br /> Garage/Accessory Struct.Size 9 I I Residential Use <br /> Number of Stories .j Proposed No.of Dwelling Units: <br /> Basement ,io ❑Yes, Fin/Unfin Total No.of Dwelling Units: / <br /> Type of Construction Wt. PlanninglLandscape Inspection Required before Final? . Yes ❑No <br /> Occupancy Group tn� , "In Lieu"Fee:Type: — Amount$ <br /> Occupancy Load ` School Impact Fee: Total $ // %�v <br /> Cert.of Occpuancy Required? ❑No !Yes ❑Shell Only Calculated: ///ff'4, Credit: <br /> Code Year ❑ 0 1 Ica2018 02015 DEverett School Dist RMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing MNew System Mot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> _. Reason Sprinklers Required: s r' 51- vas Park Impact Fee Total$ 335/ (net due after credit for existing uses) <br /> • Fire Alarm: ❑Update Existing❑New System j211\(ot Req'd Fee Schedule Used For Calculation(Year): <-.2 l /ry <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes l No <br /> Add'I RCW.64.55 docs required prior to final? ❑Yes ONo Additional Notes: 1/4 h -/ i- -y 0A. <br /> VALUATION CALCULATION: Total$ 4 <br /> 1*3-2) ()/_ t_ / ) �,� � <br /> Approved By: � , -'----Date: _2—/J=7 y <br /> 1� (yi <br /> � 6 <br /> -�- ' 11 � ) . PULICWORKS .— 312 & Intake OK by: Date:..,.,, <br /> . 02 `, 6!l` — ? a r r Intake Comments: PW Review&WorksheetNeeded if: <br /> T " _. �3C i s tJ 3 t Ct IEISys Dev Eval: <br /> •Additional Notes: • f - <br /> ❑Water ❑Sewer ❑Storm <br /> ( ❑ <br /> I Traffic Mitigation Eval <br /> Approved By: Date: I /5 �, r IDSite Work/Drainage(shown/triggered) <br /> lN IL-Address Letter <br /> FIRE DEPARTMENT 1DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: '(dental,medical,animals,mortuary, <br /> P q hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: . <br /> Additional Notes: This 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 /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> 'iLtReview/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: V., 16 >rpate: fv-•"I 6�3 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> I ❑Public Works has no scope on this permit---PW Not Required <br /> •. ELECTRICAL/PLUMBING . Additional Notes: <br /> Additional Notes: h t`I .Vt R ill 14)l v rnV nv' <br /> Approved By: Date: Completed By: Date: 12.)l' 24523 <br />