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Intake &Approval Sheet S (FOR PERMIT STAFF ONLY) • PERMIT# icll-O <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone L12 <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bld I/ ddn/Rem Size >j 2_777 I S/' Nonresidential Use l.th6( c (-itiQ..._- <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement UINo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Ill-g Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group P . —I "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 7 i School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 V2018 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: Pq2 Update Existing ❑New System El Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: 11 405 Park Impact Fee Total$LO 7.50 (net due after credit for existing uses) <br /> Fire Alarm: 1711.1pdate Existing ❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: I\OWlit U)O-tharS,, . e • 1 +0 oc i'C�7 . 9 <br /> RCW 64.55 MF worksheet req'd for permit? UYes 41.No 5 . v dtC•rc e ice_ X_ iss Q <br /> Add!RCW 64.55 dots required prior to final? ❑Yes tNo Additional�/Notes: ,,. �o <br /> VALUATION CALCULATION: Total$ 36 7r �27 (1Z (BLS " ' v r<ki c - 1 I I 1 Co 123 <br /> ( �� Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: 0 Date: 1 1 01 11,013 <br /> Intake Comments: iPW Review&Worksheet Needed if: <br /> Twit Chweit h iDSys Dev Eval: <br /> Additional Notes: V (,Q q/(,CG 13 5b 0 1 OWater ❑Sewer ❑Storm <br /> v,...),A <br /> I OTraffic Mitigation Eval <br /> Approved By: Date: IOSite Work/Drainage(shown/triggered) <br /> luAddress Letter <br /> FIRE DEPARTMENT IOBackflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Separate <br /> q hospital,supportive housing) <br /> ›EiFire Sprinklers glFire Alarm ❑Other: i <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 El Is located in this folder <br /> .ycr Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder floin with this folder for permit issuance) <br /> Approved By: t `j(,t,n Date: I )—!L.`,..-,Z5 {, 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> of.-.,27 02'y al Public Works has no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: 146 c <br /> Approved By: Date: Completed By: ,(t/jt(,r AA/ WW Date: 11 0/IZ023 <br />