Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2210^ 01 J <br /> BUILDING • •ANNING <br /> Intake OK by:At- Date: 11/2A f ZL Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ,.Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bld I/ ddn/Rem Size Oa 'j f Total No.of Dwelling Units: <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes hlo <br /> Number of Stories ftt5`( Oty "In Lieu" Fee:Type: Amount$ <br /> Basement gr�+No ❑Yes, Fin/Unfin s School Impact Fee: Total $ <br /> Type of Construction 1�-Qj Calculated: Credit: <br /> Occupancy Group 2 ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Loa. tO Park Impact Fees for permits applied fo /1/2022: <br /> Fire Sprinklers:EUpdate 'ng MI'- ystem ONot Req'd Park Impact Fee Total$ <br /> Reason Sprinklers':-•uire•. -A5 t, ' / ffo Fee Schedule Used For Calculate (Year): <br /> Fire Alarm: 5.U.•ate ting ❑Ne .-'%stem ❑Not Req'd Permit Technicians:Apply edit Per EMC19.53.200 .q. <br /> Reason Fire Alarm Required: r '-4 k 6ys nAm 0 100%Credit-Issued /1/2022-9/2/2022 �i <br /> RCW 64.55 MF worksheet req'd'or permit? ` es El No ❑ 50%Credit-Issu 9/3/2022-6/2/2023 <br /> Add'i RCW 64.55 docs required prior to final? ❑Yes 2,1No 0 0%Credit-Iss ed 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3; l0s`'7 ( Additional Notes: \N1,, l,/ W, aJ <br /> Approved By: Y ]� Date: to Al,7 � <br /> Y�'�TPPP BL IC WORKS <br /> _so____ <br /> Additional Notes: Intake OK by: Date: Vtl [04 ?al/ <br /> Intake Comments: PW Worksheet Needed if: <br /> 0/1 Mt1m of i/ (n 1 ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Approved By: f G., Date: 1 jtj'�L ., YV'`(0'J of Ulp� 4 ❑Site Work or Drainage Proposed <br /> � ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT AdskAa� l i hl 4? supportive housing) <br /> Separate I Deferred Submittals Required: El Route this folder for PW Review at end ---PW Review Worksheet <br /> Fire Sprinklers OFire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑ This Permit is Approved by Public Works <br /> Fire Dept. Fees: 0 See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder ' <br /> 0-Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: K,tjsOw.ir‘, Date: //- /�'-..:.2.f 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By:/1 Date: !`Z I"Cov <br /> [ ` r 2Z <br />