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Intake&Approval Sheet 0(FOR PERMIT STAFF ONLY) PERMIT# 0 `T O3�6 3 <br /> BUILDING . PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> intake Comments: Intake Comments: <br /> Zone H l) • <br /> 0 Make this a"W"Permit 0 SRC Required(pre-Insp) Overlay/Agreement %d *pmorrl-ttrrkt <br /> Bldg/TI/Addn/Rem Size italk-ivk Nonresidential Use Vetti.1 \ems an et se rvic.es <br /> Garage/Accessory Struct.Size L2 444.4y1 Residential Use Lijpc <br /> Number of Stories R1M61.i^ • Proposed No.of Dwelling Units: mil., . <br /> Basement &No CIYes, Fin I Unfin Total No.of Dwelling Units: by,ios • <br /> Type of Construction b Planning/Landscape Inspection Required before Final? CIYes IZINo ' <br /> Occupancy Group AV' 4- 6. "In Lieu"Fee:Type: Amount$ ce <br /> Occupancy Load I1-In.L'l • School Impact Fee: Total $t ij pi— Cs y c m y Q, 1t <br /> Cert.of Occpuancy Required? No EIYes QShelI Only Calculated: 95 Credit: V <br /> Code Year E12021 li42018 E12015 DIEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: pdate Existing DNew System CINot Req'd Park Impact Fees for permits applied for after 11112022: <br /> -• Reason Sprinklers Required: AtA okixre v 3.4 Park Impact Fee Total$ NI Pc (net due after credit for exisffng uses) • <br /> Fire Alarm: 'Update Existing El New System DNot Req'd Fee Schedule Used For Calculation(Year): N J Pr <br /> N m m momm..•.m M.1yY11 ^^ .,,m <br /> Reason Fire Alarm Required: V Vt5t fi 6 <br /> RCW 64.55 MF worksheet req'd for permit? ElYes 14 No . <br /> Addl RCW.64.55 does required prior to final? I—IYes IgNo Additional Notes: <br /> . <br /> VALUATION CALCULATION: Total$ 7-0,il% ' • <br /> Approved By: _, --..----- Date: 031 i1.f 2 2-4 <br /> vj PU81..IC'1NORKS . , . . <br /> Intake OK by: Date: _ _ _ <br /> • Intake Comments: • f PWRevietat1&WorksheetNeeded if m �„ <br /> . ,QSys Dev Eval: <br /> Additional Notes: Yke") ototv� it,l' lfL-Co Imo` QWater QSewer QStorm <br /> • Q.0el�0 (,..n` . w 1 2e/' w I0 [QTraffic Mitigation Eva1, <br /> Approved By: •Date: 4 / ( i - IQSite Work/Drainage(shown/triggered) <br /> • IQAddress Letter <br /> FIR?. DENARTM1~11 QBackfow Prevention for high hazard: <br /> 1(dental,Medical,animals,mortuary, <br /> Separate I Deferred Submittals Required: (hospital,supportive housing) <br /> DIFire Sprinklers ElFire Alarm ClOther: • <br /> Additional Notes: . 0 This Permit Is Approved by Public Works • <br /> . El See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: C(A Separate PW Permit is Required(Permit#:PW ) • <br /> El Review of As-Built Plans NO FIRE FEE AND CI Is fully digitai <br /> CI Minimal or No Fire Scope-NO FIRE FEE CI Is located in this folder <br /> AReview/Inspection Scope-ADD FIRE FEE ID is in a Separate Green Folder(join with this fotderfor permit Issuance) <br /> Approved By: 4 "JYI Date: -.3 S_ 1 0 Will be issued separately(Separate Green Folder,PW issued ahead of Side) <br /> Public Works hae•no scope on this permit---PW Not Required <br /> ELEGT.RICAL/PLIIM33ING . Additional Notes: <br /> b • <br /> Additional Notes: <br /> Approved By: Date: jCompleted By: .4! fy Ic 0 y; Date: ©3—/3 - Z y <br />