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0 <br /> 411I <br /> Intake &Approval Sheet OR PERMIT STAFF ONLY) RMIT# V i o( '-IOLt <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: t Assign To:Jess Date:1/1 112-( <br /> Intake Comments: Intake Comment . <br /> Zone R-1 <br /> ❑Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement 51aQwa11c pctort-irtl <br /> Bldg/TI/Addn�re Size i -}o te�,.ruv,. Nonresidential Use L3/!a <br /> Garage/Accessory Struct.Size ® ne�J.i -Fo byte l-x Residential Use 5V9. <br /> Number of Stories I Proposed No.of Dwelling Units: ty/A <br /> Basement INo ❑Yes, Fin/Unfin Total No.of Dwelling Units: N/A <br /> Type of Construction 7/2. Planning/Landscape Inspection Required before Final? ❑Yes ®No <br /> Occupancy Group 7414- "In Lieu"Fee:Type: Amount$ cD <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? INo Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 CQ2018. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System OSIot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing El New System JNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes JNo <br /> Add'I RCW 64.55 does required prior to final? ❑Yes VINo Additional Notes: <br /> VALUATION CALCULATION: Total$ 73,o <br /> Approved By, ete Date:I//I/21-1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ['Sys Dev Eval: <br /> Additional Notes: SCAr. (;iifeel to'W6t. lea" OWater ❑Sewer ❑Storm <br /> 6C✓( OTraffic Mitigation Eval <br /> Approved By: (,/( / Date:(��j/p�'y(� ;OSite Work/Drainage(shown/triggered) <br /> l�// OAddress Letter <br /> FIRE DEPARTMENT OBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> '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: 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 0 Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 1., ublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: ` <br /> Approved By: Date: Completed Bq:�"( ��j J v '1%., Date: (J 1( 170 7,`'f <br />