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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#V.23230-02�� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone (///0 3 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size 01 Nonresidential Use <br /> Garage/Accessory Struct. Size (,05 Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: /9 <br /> Basement QNo DYes , Fin/Unfin Total No. of Dwelling Units: /y <br /> Type of Construction �(�, Planning/Landscape Inspection Required before Final? gYes ❑No <br /> Occupancy Group "In Lieu" Fee:Type:_ Amount$ <br /> Occupancy Load School Impact Fee: Total $ // f y� <br /> Cert. of Occpuancy Required? ❑Noyes ❑Shell Only Calculated: Ji' f( Y' Credit: —0-- <br /> Code Year 02021 1E1.2018 02015 DEverett School Dist gmukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 3/f O (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System ®Not Req'd Fee Schedule Used For Calculation(Year): c 2 OZ 3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes `P`No <br /> Add'I RCW 64.55 docs required prior to final? El Yes KNo Additional Notes: <br /> VALUATION CALCULATION: Total $ Sxf p <br /> Approved By: / Date: /0 ;,2G _?3 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: 1PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> ❑Water DSewer ❑Storm <br /> Additional Notes: <br /> ❑Traffic Mitigation Eval <br /> Approved By: c(j Date: 1,91f, 1❑Site Work/Drainage(shown/triggered) <br /> •. a-S <br /> DAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: '(dental, medical,animals,mortuary, <br /> p q [hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: ;;,,{{.This 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 /> 0,Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> AlReview/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: (� r 7 Date:ft -27-2.5 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope on this permit--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed B . Date: <v/o/yt.,,z,S <br />