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Intake &Approval Sheet •OR PERMIT STAFF ONLY) •RMIT# F 3 l -054( <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:Ga' +1 Date: li$'Zif <br /> Intake Comments: intake Comments: <br /> Zone t(43 <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bidg/Ti/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes .glNo <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School impact Fee: Total $ <br /> Cert.of Occpuancy Required? 1531No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 1132018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing Chew System INot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ONew System SNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for permit? ❑Yes ®-No <br /> Add'LRCW..64.55 does required prior tofinal? ❑Yes No Additional Notes: jfCo'61011POm/ geo'wi (041-o' kitcori <br /> VALUATION CALCULATION: Total$ DbO <br /> Approved By:f �ffoiie.„-- Date: ifyzy <br /> PUBLIC•WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&WorksheetNeeded if:: <br /> • QSys Dev Eval: <br /> Additional Notes: • ClWater OSewer ❑Storm <br /> DTraffic Mitigation Eval <br /> fDSiteWorkJDrainaoe(shown/tritioered) <br /> Approved By: G ^ Date: )47111A <br /> !DAddress Letter <br /> FIRE DEPARTMENT IDBackflow 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 ❑ Is fully digital <br /> 9 Minimal or No Fire Scope-NO FIRE FEE ❑ is located in this folder <br /> ❑ Review/inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with thrs folder for permit issuance) <br /> Approved By:\ .6,(lj-yti n Date: — l(2—� ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> pdPublic Works has no scope on this permit---PW Not Required <br /> • ELEGTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Z Date: /2-125lZoti <br />