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Intake &Approval Sheet FOR PERMIT STAFF ONLY) =RM1T# Vp;`-f O,2_, - 0 .- $ <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 0 SRC Required(Pre-Insp) Overlay/Agreement • <br /> Bldgflh/Addn/Rem Size ill Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories k Proposed No.of Dwelling Units: , <br /> Basement 11No ❑Yes, Pin/Unfin Total No.of Dwelling Units: ' <br /> Type of Construction V/ PlanninglLandscape Inspection Required before Final? [(Yes ONo <br /> Occupancy Group "in Lieu"Fee:Type: Amount$ <br /> Occupancy Load 46. School impact Fee: Total $ . <br /> Cert.of Occppancy Required? ❑No IYes }Shell Only Calculated: Credit: <br /> Code Year 02021 112018 E12015 QEverett School Dist L_1Mukiilteo School Dist <br /> Fire Sprinklers:DUpdate Existing LONew System ElNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Mew <br /> impact Fee Total$ ' (net due after credit forexisftng uses) <br /> Fire Alarm: Update Existing f�Ptew System ONot Req'd Fee Schedule Used For Calcuiation(Year): „^ —nym^... <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ®No <br /> Add'l RCW.64.55 docs required prior to final? JYes ElNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 6i.",WN <br /> Approved By: 413 Date: 4 1�/2. <br /> PuB LIC WORKS . . <br /> Intake OK by: Date: O 2,12 b[2,024 <br /> • Intake Comments: FW Review&WWorksheet Needed if: <br /> _ <br /> • • C91441,jnej f� Sys Day Eval: <br /> Additional Notes: flWater bSewer Storm <br /> © e2�tf ti �O il-�lhCYe4Se" 10Traffic Mitigation Eval <br /> Approved By: C,, Date: VIA A, OP' 1 nzQ�N 10I-CS" IElSite Work/Drainage(shown/triggered) <br /> • /v 0 3P.1-t t-�o�r' j f oAddress Letter <br /> FI1I DEPARTMENT pYa nDSe IE1Sacktiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: f `(dental,medical,animals,mortuary, <br /> pq N© A) 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 /> El Review of As-Built Plans-NO FIRE FEE AND Q Is fully digital <br /> LI Minimal or No Fire Scope-NO FIRE FEE DI Is located in this folder <br /> IS-Review/inspection Scope-ADD FIRE FEE ❑ is in a Separate Green Folder Qoin with this folder for permit issuance) <br /> Approved By: Cti S)�U ft\ Date: a2 i2CO ."24' El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Q Public Works has no scope on this permit—PW Not Required <br /> ELEGTRICALIPLUMBING Additional Notes: <br /> . <br /> Additional Notes:Approved By: Date: Completed Datg �'j19 g l <br />