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Intake &Approval (FOR PERMIT STAFF ONLY) PERMIT# 13231 0- D g <br /> PP Sheet <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:\t•-k Date: l0(30)2.3 <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> BldglTl/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size •^— Residential Use \I4S <br /> Number of Stories 2 Proposed No.of Dwelling Units: 4 o <br /> Basement lNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction y'AC. Planning/Landscape Inspection Required before Final? ❑Yes EINo <br /> Occupancy Group ILL "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? "INo DYesF, ❑Shell Only Calculated: Credit: <br /> ❑ �I <br /> Code Year 2021 2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System KNot 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 ❑New System ;Not Req'd Fee Schedule Used For C culation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes fa, 1'No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes a�tivo Additional Notes: <br /> VALUATION CALCULATION: Total$ (04.1 00 <br /> Approved By:7-46�2�i'// i�'r Date: /'/Bj2,3 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water DSewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: CAOf'J".� Date: II in/Z,3 ❑Site Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate I Deferred Submittals (dental,medical,animals,mortuary, <br /> p Required: hospital,supportivehousing) <br /> housing) <br /> ❑Fire 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 /> ❑ 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 this folder for permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING <br /> dditional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: I Z Date: (©1 <br />