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its ��AS A ANTRMU-- <br /> Intake &Approval Sheet (PERMIT STAFF ONLY) IT#J? ?o l ©—.S <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone /7/!). <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bidg/TI/Addn/Rem Size i "- Nonresidential Use .-- <br /> Garage/Accessory Struct.Size 4 (( Residential Use y <br /> Number of Stories ' Proposed No.of Dwelling Units: / <br /> ❑YesDwelling Basement No , Fin/Unfin Total No.of Units: <br /> Type of Construction , 2-C PlanninglLandscape Inspection Required before Final? EiYes ❑No <br /> Occupancy Group t "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load \ (-C School Impact Fee: Total $ J/ I, ._ <br /> Cert.of Occpuancy Required? El No Wes ❑Shell Only Calculated: // Y`6,�/ Credit: '� <br /> Code Year 020 IX2018 02015 DEverett School Dist l(LTbiukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing NI New System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: I—1-\ Vt. U N l'i Park Impact Fee Total$ 3 3 3/ `(net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): a core <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes RIM <br /> Add'i RCW 64.55 does required prior to final? ❑Yes lklo Additional Notes: A7,4G /k jed—ey it / r1uNr,.j <br /> VALUATION CALCULATION: Total$ C/ <br /> t a r] L�0 6 6 gat _. <br /> By: A (�� Date: 2 %J; Z)' _ <br /> I )4 6 if T d,c130c( PUBLIC WORKS <br /> , G If — �- OC Intake OK by: Date: <br /> f � Intake Comments: IPW ReviewS Worksheet Needed if: <br /> 3 (5 d-3(1 I EISys Dev Eval: <br /> Additional Notes: i ❑Water ❑Sewer ❑Storm <br /> DTraffic Mitigation Eval <br /> Approved B�� Date: o y� `2?� f©Sife Work/Drainage(shown/triggered) <br /> /` QAddress Letter <br /> FIRE DEPARTMENT ,❑Backfiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: Ihospita(dental,medical,r animals,mortuary, <br /> Separate supportive housing) <br /> ❑Fire Sprinklers ['Fire Alarm ❑Other: <br /> Additional Notes: 17gThis 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 0 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 0 Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By:It< IT,co(�,y) Date: 1,2 L 3 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has noscope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: n0 ;GOV, 411 q it(M e2(1411 4 <br /> Approved By: Date: Completed By: Aj/AMAAt Jkitinviit. Date: t2-I 1 b 12,0 213 <br />