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Intake & Appx'oval Sheet (FOR PERMIT STAFF ONLY) Pl~RMIT�#� <br />BUILDING <br />Intake )K by; Date: <br />Intaka comments: <br />❑ Make this a "W" Permit ❑ 8RC Required Pra•Ini ) <br />1dgiTilAddnlRem Size <br />aragelAccessory Struct, Size <br />N m er of Storles <br />>3asernent 1No Ole-, Fin i Unfin <br />Type of Construction <br />occupancy Group <br />Occupancy load <br />Lett, of Oocpuancy Req tied? allo ElYes Shell Only <br />Cade Year p2021 IA2018 02016 <br />Flre Sprinklers: rUpdate Existing E1N❑w System 1--- w Req'd <br />Reason Sptinkle Required: <br />Fire Alarm: Update Existing ❑New system CIN❑t Reced <br />Reason Fire Al rm Required: <br />RGW 64.66 MF w sbeat reV for penritt7 aYes 0 No <br />Add1 RGW. 64,58 docs a uired priorto final? L]Yes 1INo <br />VALUATION CALCULATION __- -T"al is <br />Notes: ^ /1 ' <br />(Approved By: Z -/-� 2i &,X`1 17ate: `7 <br />T—T <br />Separate 1 Dafarred submittals Requited: <br />E]Ffre sprinklers ElFire Alarm 00ther: <br />Additional Notes: <br />Fire Dept. Fees: <br />E( Review of As.-Hullt Plans.. NO FIRE FEE <br />L] Minimal or No Fire Scope •• NO FIRE FEE <br />11 Review! Inspection Scope ..ADD FIRE~ FEF <br />Approved)3y. pate: <br />F.Li~GT.RICAL/p1.UMBiNG <br />Additional Notes: <br />Approved BY. bate: <br />PLANNiNG <br />OK by: Assign To: <br />Comments: <br />OverlaylAgreement <br />Nonresidential Use <br />Residential Use <br />Proposed No, of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planningll andscape lnspection Requir before Final? GYes 0No <br />"in Lleu" Pee: Typo: Amount $ <br />School Impact Fee: Total $ ` <br />Calculated: Credit: <br />pFverett School Dist ukiitec School Dist <br />Park Impact lees for permI applied for after 11112022: <br />Park impact Fee Total (net due after credit for existing uses) <br />Fee Schedule Used For Calc Patton (Year): <br />Additional Notes: <br />Approved Dy: !. Aate: <br />l'U1 UG W®140 <br />Intake OK by: <br />Intake Comments: PWRevfew & WorksheetNeededif• <br />ElSys Dev E=val : <br />ElWater USewer bStolm <br />tbTraffic Mitigation Evai, <br />IElsite Work/Drainage (shown/triggered) <br />IaAddress Letter <br />El6ackilow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />lhospital, supportive housing) <br />r <br />This Permit Is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />EJ A Separate PW Permit is Required (Permlt#: PW ) <br />AND ❑ Is fully digital <br />El Is located in this folder <br />a Is in a Separate Green Folder iiornwiththfaNderforpermrt(ssuance) <br />11 Will be Issued Separately (Separate Green Folder, PW issued ahead of Bldg) <br />p Public Works has•ne scope on this permit--.. PW Not Required <br />Additional Notes: <br />Completed k3,y: pate: <br />C4 <br />