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Intake &Approval Sheet OR PERMIT STAFF ONLY) •RMIT# t c3 1,02— 0(5 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 17 �( <br /> 0 Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> d2/Ti/Addrl 2e Size 17s, e.k tYq Nonresidential Use <br /> rage/ ccessory Struct.Size 31�- Residential Use j _. <br /> Number of Stories If Proposed No.of Dwelling Units: <br /> Basement 'No Oyes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction 711-- Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group ZC c "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 77p't, School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? EiNo ❑Yes ['Shell Only Calculated: Credit: <br /> Code Year 02021 142018 02015 ['Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing [hew System !Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ '7. (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? DYes No <br /> Add!RCW.64.55 dots required prior to final? Dyes!! No Addition Notes::4 IN <br /> VALUATION CALCULATION: Total$ Zbr Jl Q KI/,Q�� \ IZ Appro ed By: III Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: 1PWReview&Worksheet Needed if: <br /> • ,JDSys Dev Eval: <br /> Additional Notes: p 5 ❑Water OSewer OStorm <br /> 1W � G 11€['Traffic Mitigation Eval <br /> Approved By: up.� A. ?�Date: ( � z(]Site Work/Drainage(shown/triggered) <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 /> ❑Fire Sprinklers ❑Fire Alarm ['Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> . 0 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 /> ❑Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder Coin with this foiderfor permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> A,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,/ asp,,„ Date: )12 -7a^,073 <br /> v <br />