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Intake &A Pp,roval Sheet PERMIT STAFF ONLY) �IIT#t <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: intake.Comments: <br /> Zone /(/DS <br /> ❑Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement • --- <br /> Bldg/TI/Addn/Rem Size MI- Nonresidential Use — <br /> Garage/Accessory Struct.Size 1 )I Residential Use y <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basemento ❑Yes, Fin/Unfin Total No.of Dwelling Units: 1 <br /> Type of Construction t KC Planning/Landscape Inspection Required before Final? Wes ❑No <br /> Occupancy Group I "In Lieu"Fee:Type: `" Amount$ <br /> Occupancy Load 141 \(Z..0 School Impact Fee: Total $ li/ SVG <br /> Cert.of Occpuancy Required? ❑No lY,es ❑Shell Only Calculated: )/�if — Credit: <br /> Code"Year 02021,�,� IL13-2018 02015 DEverett School Dist DAMukilteo School Dist <br /> Fire Sprinklers: El Update Existing IV/New System ❑Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> _. Reason Sprinklers Required: 1 1-1 S (N1 Park Impact Fee Total$ JJ1 (net due(after credit for existing uses) <br /> • Fire Alarm: El Update Existing El New System IgiNot Req'd Fee Schedule Used For Calculation(Year): c2 00/ <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1;83 No <br /> Add'I RCW.64.55 docs required prior to final? Dyes giNo Additional Notes: g/UJ /� JUAtt/ty A71 it N? h' <br /> VALUATION CALCULATION: Total$ f/ l/ <br /> 31 - og L(. Approved By: mate: a -/s -2 j/ <br /> 17a7 A 166-0-g6; 6V-- PUBLIC WORKS <br /> > i c — a6, 30 <br /> Intake OK by: Date: <br /> )C Cle -' 02 04'r Intake Comments: EPW Review 8 Worksheet Needed if: <br /> g(S`Q3 'QSys Dev Eval: <br /> Additional Notes:Additional <br /> ❑Sewer OStorm <br /> ,❑Traf is Mitigation Eval <br /> Approved Byt:1/4_49.)- r4 Date: 1 /5 I LASite Work/Drainage(shown/triggered) <br /> (]Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,Separate/Deferred Submittals Required: hospital,supportivemupot animals,mortuary, <br /> p q housing) <br /> ❑Fire Sprinklers El Fire Alarm ❑Other: . <br /> Additional Notes: VI 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 /> -Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor permit Issuance) <br /> Approved By:K S6(-c-7u/D Date: /,2„-w ❑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: Vt0 c(, 1 ' +t)h ►'re‘4 t ov$1 ' <br /> Approved By: Date: Completed B : , / ', dv Date: 1,111312623 <br />