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BB10— o42. <br /> Intake &Approval Sheet OR PERMIT STAFF ONLY) ERMIT# . I '0 <br /> BUILDING PLANNING <br /> Intake OK by: 1- Date: -, ? +- Intake OK by: Assign To: Date: <br /> Intake Comments: ri G i� Intake Comments: <br /> PW4 Zone 12'P� <br /> ❑ Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> 0... <br /> Garage/Accessory Struct. Size Residential Use PF14 <br /> Number of Stories 1 Proposed No.of Dwelling Units: <br /> Basement EiNo ❑Yes, Fin L Unfin Total No.of Dwelling Units: <br /> Type of Construction N/AC CV 0 Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group , V "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ►= o :`'V•,. Shell Only Calculated: Credit: <br /> Code Year LI 021 132018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: �ry Park Impact Fee Total$ V (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System Not Req'd Fee Schedule Used For Calculation(Year): mmx^,__ ._ ___ _, _ .... <br /> Reason Fire Alarm Required: 11� <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes J No <br /> t,2C <br /> Add'I RCW 64.55 does required prior to final? ❑Yes ®iVo Additional Notes:� "l IZ/� <br /> �f <br /> VALUATION CALCULATION: Total$ �� 16 1,011(e / -T <br /> Aoved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: 1,0 16( 12,3 <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> I DSys Dev Eval: <br /> Additional foot s: ❑Water ❑Sewer ❑Storm <br /> (,� 1 1 r 1 � �G^tt `' OTraffic Mitigation Eval <br /> Approved By: 7 ,---1 Date: 1i G/� ❑Site Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT DBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate I Deferred Submittals Required: ihospital,suportive housing)DFire Sprinklers El Fire Alarm ❑Other: 1 <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 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 /> "21 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(loin with this folder for permit issuance) <br /> Approved By:\4/`191 C[7fd� Date: I I r,23 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 11 Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:'�AA Date: 10 01 1 7-3 <br />