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. ,( 6'I J'JS —iT . ir?P(<O01-.' • —�o f <br /> Intake &Approval Sheet PERMIT STAFF ONLY) m i1T# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ,/L/ <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-lnsp) Overlay/Agreement • <br /> Bldg/TI/Addn/Rem Size )-11,7' Nonresidential Use — <br /> Garage/Accessory Struct.Size 9 0 Residential Use LJ <br /> Number of Stories S Proposed No.of Dwelling Units: I <br /> Basement 'No DYes, Fin/Unfin Total No.of Dwelling Units: / <br /> Type of Construction ' 1-t Planning/Landscape Inspection Required before Final? glYes ONo <br /> Occupancy Group 1(, "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load \ \LC School Impact Fee: Total $ //f g f(O <br /> Cert.of Occpuancy Required? ❑No 1(es ❑Shell Only Calculated: /6 g‘a- Credit: -9 <br /> Code Year 1220,21 I2018 012015 DEverett School Dist ElIvlukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing MNew System ❑Not Req'd/ Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: I�f 5-1- U N1f5 Park Impact Fee Total$ 3,33/ (net due after credit for existing uses) <br /> • Fire Alarm: El Update Existing❑New System VI,Not Req'd Fee Schedule Used For Calculation(Year): 0 2 V <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes i1 No �/ / <br /> Add'I KW.64.55 docs required prior to final? ❑Yes !4 o Additional Notes: PJ4b,� �G ram/ A ,6-4 M• l( <br /> VALUATION CALCULATION: Total$ _. 14V`7 8(� U �/ <br /> l 7a7 ‘6 — oZ g6 G` f O3�{ Approved By: _ Date: -/1 Z '� <br /> L4 C 61( 1-1 I <br /> PUBLIC WORKS • , <br /> gall>4"6 .2(0 4 r Intake OK by: Date <br /> intake Comments: PW Review&Worksheet Needed if: <br /> • ❑Sys Dev Eval: <br /> • <br /> ❑Water ❑Sewer ❑Storm <br /> Additional Notes: <br /> A <br /> DTraffic Mitigation Eval <br /> Approved By:t. 'a , / Date: % i 5'Z`� OSife Work/Drainage(shown/triggered) <br /> IIDAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,r animals,mortuary, <br /> Se <br /> P q Ihospital,supportive housing) <br /> El Fire Sprinklers El Fire Alarm El Other: <br /> Additional Notes: 150 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 0 Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit Issuance) <br /> Approved By:4,` �J�ate:��,� El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> �w�� ❑Public Works has no scope on this permit---PW Not Required <br /> •• ELECTRICAL/PLUMBING Additional Notes: , <br /> Additional Notes: vizC,ri a / UI " ivi�✓✓(on J <br /> Approved By: Date: Completed By: r A,I, Date: RI 6 I2023 <br />