Laserfiche WebLink
Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# e' 0 9_es) Sl <br /> 1 rl_ �� <br /> BUILDING _ -ANNING fl 0 q _ eoY <br /> Intake OK by: 6 f l ` Date: kk '317;1-- Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone g-,Z <br /> Overlay/Agreement N/A <br /> ❑ Route to Commercial Building Nonresidential Use {V/A <br /> -Route to Residential Building Residential Use SF R } AP _ <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: ` <br /> Id I/Addn/Rem Size /30 5 F Total No. of Dwelling Units: Z <br /> Garag ccessory Struct. Size %01 SF Planning/Landscape Inspection Required before Final? DYes ,®No <br /> Number of Stories Z "In Lieu" Fee:Type: Amount$ <br /> Basement gl"No DYes , Fin/Unfin re: Total $ <br /> Type of Construction Te...L -Oafetfeted;- Credit: <br /> Occupancy Group 'Sok ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load S(2.-C., Park Impact Fees for permits applied for after 1/1/2022: <br /> 114L '1 <br /> Fire Sprinklers: DUpdate Existing ONew System Not Req'd Park Impact Fee Total$ 1 I I <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 2O 2 Z- <br /> Fire Alarm: DUpdate Existing ❑New System ElNot Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: Ott 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> E <br /> RCW 64.55 MF worksheet req'd for permit? DYes No _CYy 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? DYes ®No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 136/302_ Additional Notes:Vericled Cornpliavlc2 o)i+1l RE\IIUZt-OZ2 <br /> JadirlC�- q`'�fi5c ,�17A 9� +Moc1(;rLca}ion oC devetoprnenir SA-ar,dards . <br /> ici3plSF I Ctssued bH arokc,e 41Ql/2z) <br /> b 6E- 30i S, 4 5I Is F = itIS,4oZ Approved By: Date: l p�Z O l ZZ <br /> 33001 PUBLIC WORKS <br /> tiZx 1,5 A5� <br /> ©1,I2l l zv <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: ,`.RA PW Worksheet Needed if:20X 1ZYI'W U_ ok P4ri6I lilSys Dev Eval ,,Traffic Mit Eval <br /> Approved By: Date: kb Z �M 3 I 1 IJi Site Work or Drainage Proposed <br /> I I �"� .4 w^ rre 161,11S' MO 41 ❑Backflow Prevention for high hazard: <br /> `I �y (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT `ill�P CI,��� �ni t,,,,,Q 601I2 supportive housing) <br /> Separate/Deferred Submittals Required: Route this folder P`W Review at end ---PW Review Worksheet <br /> 0 Fire Sprinklers ❑Fire Alarm DOther: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> 0 This Permit is Approved by Public Works <br /> Fire Dept. Fees: 14 See PW Review Worksheet and associated attached items <br /> A Separate PW Permit is Required (Permit#: PW 230z-ODD <br /> CI Review of As-Built Plans-NO FIRE FEE � p ) <br /> ig Minimal or No Fire Scope-NO FIRE FEE AND gi 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:K,tycck km Date:`\- ,:J'O` ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes:pt./a4l wovi fccACej-u au -i �[4.-1 lao?›, <br /> Additional Notes: tt re1 t-vi ev I(Ib1202J3 • <br /> Approved By: Date: Approved By:+W 1,�+"tryikgVyx, Date: 0240 112023 <br /> U <br /> 2:-/z___ <br />