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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# D 3 r(2_-(9 3< <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:�aj/11 Date:2/i3/2.41 <br /> Intake Comments: Intake Comments: <br /> Zone16 <br /> 0 Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg )Addn/Rem Size ( 05 $'F Nonresidential Use U es i HA/yA (/,ih. <br /> Garage/Accessory Struct.Size Residential Use f <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement El No ❑Yes, Fin/Untie Total No.of Dwelling Units: <br /> Type of Construction t3_.,4 Planning/Landscape Inspection Required before Final? DYes 'No <br /> Occupancy Group p "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load te <br /> �) / School Impact Fee: Total $__ <br /> Cert.of Occpuancy Required? ❑No IYds DShell Only Calculated: Credit: <br /> Code Year �/ 02021 V12018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑ ti a Existing❑New System ❑Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: 005#475 Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: lifUete Existing New System ❑Not Req'd Fee Schedule Used For C Iculation(Year): <br /> Reason Fire Alarm Required: aff ek0f1-3 <br /> RCW 64.55 MF worksheet req'd for permit? Yes of No <br /> Add'I RCW.64.55 docs required prior to final? ❑Yes tANo Additional Notes: Cre i/ ii, °`�' .PG!t/ ®cvr k T/, <br /> VALUATION CALCULATION: Total$ J T0179 <br /> / <br /> Approved By:7 &Ii rA_ Date: 0/27/ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: [PW Review&Worksheet Needed if: <br /> • ❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> f OTraffic Mitigation Eval <br /> Approved By: 1, Date: 1/ •0 /iS/, II 0Site Work/Drainage(shown/triggered) <br /> V IDAddress Letter <br /> FIRE DEPARTMENT 'DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: hospital, <br /> (dental,medical,r animals,mortuary, <br /> p q hospital,supportive housing) <br /> 46-Fire Sprinklers jiZIFire Alarm ❑Other: <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> . ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#:PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> 12'T2eview/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder uoin with this folder for permit issuance) <br /> Approved By:V„tc.. Gt,‹N Date: \_.\D-2y ❑Willbeissuedseparately(SeparateGreenFolder,PWissuedaheadofBidg) <br /> 111JJJ Public Works has no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed By:>4�/�% Date: jz3Q f .o23 <br />