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Intake &Approval Sheet bR PERMIT STAFF ONLY) •RMIT# 6013102 --00 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: 'cif' Assign To:JP.SS Date: 121Z$/Z3 <br /> Intake Comments: Intake Comma ll!! <br /> Zone M U <br /> 0 Make this ..',I Per ' 0 SRC Required(Pre-Insp) Overlay/Agreement AIA, AcA <br /> Bldg/TI/Add 'ern Size c SOO Nonresidential Use food a beverage es-tablishwren+ <br /> Garage/Ace-.sory St . t.Size Residential Use t•VA <br /> Number of Stories I Proposed No.of Dwelling Units: N/A <br /> Basement JNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: N/A <br /> Type of Construction U 5 PlanninglLandscape Inspection Required before Final? ❑Yes INo <br /> Occupancy Group A-. 6 . "In Lieu"Fee:Type: Amount$ 0 <br /> Occupancy Load 7I School Impact Fee: Total $ 0 <br /> Cert. of Occpuancy Required? ONo ]Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 1)12018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: PA pdate Existing Mew System ❑Not Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: lilmAy .0.y014. Park Impact Fee Total$ V (net due after credit for existing uses) <br /> Fire Alarm: Update Existing El New System El Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: Amy (G <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add!RCW.64.55 does required prior to final? Dyes No Additional Notes: <br /> VALUATION CALCULATION: Total$ J O , <br /> Approved BI Date:12/Z 8/23 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> 1*' tau S*, GS , ❑Sys Dev Eval: <br /> Additional Notes: nCr 4-pc, 1*w,ppvi ❑Water OSewer ❑Storm <br /> I eU151 ' -*O f Pld- .. • I DTraffic Mitigation Eval <br /> Approved By: Date: 'Zj" iOlSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT IDBackflow Prevention for high hazard: <br /> - <br /> Separate/Deferred Submittals Required: , , , , <br /> p q hospital(dental ,medical supportiveanimals housing) <br /> mortuary <br /> 'Fire Sprinklers ,Fire Alarm ❑Other: I <br /> Additional Notes: 0 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 /> ❑ 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(ioin with this folder for permit issuance) <br /> ), <br /> Approved By:' l C.c)(N Date: )�� �f ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> `' ublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> T -reb Cs,Sf eecOCC. SAsP .46 [NAa6.It oa% JSt. <br /> Additional Notes: 14 r• 'Pees <br /> Approved By: Date: Completed By:'�„�P�,.. Date: pr..e•s..t 1ov <br />