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VI 0 1 <br />FOR OFFICE USE ONLY PERMIT # C l _C 1 <br />BUILDING <br />Bldg/TI/Addn/Rem Size <br />A6 7 Z S/" <br />Garage Size <br />VALUATION <br />4�o <br />Number of Stories <br />Z <br />Occupancy Group <br />A <br />Occupant Load <br />Basement <br />No <br />XYes Fin / Unfin <br />Type of Construction <br />Existing Sprinkler System? <br />Yes <br />No Unk <br />Fire Sprinkler Required <br />Yes <br />No <br />Reason <br />Existing Fire Alarm <br />Yes <br />No Unk <br />Fire Alarm Required <br />Yes <br />No <br />Reason <br />Enclosure Law Applies lYes <br />Deferred Submittal Req'd <br />Yes <br />_ No <br />Approved by: <br />Date:= 17 I <br />Comments: 201s <br />Intake OK by: <br />FEES: <br />Plan Check Fee <br />Building Permit <br />Surcharge <br />Additional Plan Check <br />Plumbing Fee <br />Mechanical Fee <br />Ping Bldg Review Fee <br />Water Fee <br />Sewer Fee <br />Systems Dev. Fee <br />Traffic Mitigation Fee <br />Public Works Fee <br />School Mitigation Fee <br />PLANNING <br />Zoning Classification <br />Overlay/Agreement <br />CIA; - (� <br />Nonresidential Use <br />Residential Use <br />Ll 2 S <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />'J4 <br />'1 <br />Landscape or Planning Inspection <br />needed before final? Yes No <br />Planning Inspector: <br />Phone #: <br />Approved by: Date: <br />Historic Approved by: — Date: <br />School Mitigation Reqd? Yes No <br />Everett School Dist _)�_ Mukilteo School Dist <br /># of Net New Units: I v61 <br />Calculated School Impact Fee: 14 <br />School Impact Fee Credit: <br />Total School Impact Fee Owed: <br />Comments: LAOjsc - <br />19 �' 1 6;' AO \ <br />Intake OK by: )�-% <br />INTAKE: Checked By:,_ - Z: ,1' Date: lo( -,;�17- b(U/b <br />Comments: 2 4Up4F"C S -- I S/* 'Plan � 2 oval <br />High Hazard Sites (Dental, Medical, Animals, Mortuary, etc -Review for RPBA) <br />❑ Public Works / Sys Dev / Traffic Mit. / RPBA - NOT REQUIRED <br />❑ Route for Public Works Review (bldg folder, PW Worksheet) <br />Nf Public Works Permit-Concu rent Review separate green folder <br />PW REVIEW: PW Reviewer: J�Date: 0 <br />� PW Permit Approved - PW 1419 - Oq3 <br />See PW Review Worksheet <br />❑ PW Permit Not Required <br />FIRE <br />DEPARTMENT, . <br />Update/New Sprinklers <br />Yes _ <br />No Existing Bldg._ <br />Update/ New Detection <br />Yes _ <br />No Existing Bldg. _ <br />Update/ New Chemical <br />Yes <br />No Existing Bldg. _ <br />Update/ New Fire Service <br />Yes <br />No Existing Bldg. _ <br />Approved by: <br />Date: - Ll - Yl <br />Comments: <br />