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Intake&Approval Sheet •FOR PERMIT STAFF ONLY) dIERM1T# P(2.(4-() (009—
<br /> BUILDING L . PrTNNING
<br /> intake OK by: Date: Intake OK by: Assign To:<Ad t Date: 3/1 A i 2 IA
<br /> Intake Comments: Intake Comments:
<br /> Zone Ut4 .
<br /> ❑Make this a"W"Permit ❑SRC Required(Pre-insp) Overlay/Agreement •
<br /> Bldg/Ti/Addn/Rem Size re 14,441 Nonresidential Use
<br /> GaragelAccessory Struct.Size 14 w.aA,kA Residential Use - 416
<br /> Number of Stories IL,e44..k,v, Proposed No.of Dwelling Units: "/"p .
<br /> Basement 'BIND ElYess, Fin/Unfin Total No.of Dwelling Units:
<br /> Type of Construction ppv--A Planning/Landscape Inspection Required before Final? DYes, No •
<br /> Occupancy Group I&`- . "In Lieu"Fee:Type: Amount$
<br /> Occupancy Load k61116.a School Impact Fee: Total $ (�
<br /> Cert.of Occpuancy Required? to DYes EIShell Only Calculated: / Credit:
<br /> Code Year 02021 M2018 012015 DEverett School Dist ❑Mukilteo School Dist
<br /> Fire Sprinklers:DUpdate Existing ONew System lNot Req'd Park Impact Fees for permits applied for after 11112022:
<br /> Reason Sprinklers Required: Park impact Fee Total$ '/! (net due after credit for existing uses)
<br /> Fire Alarm: ElUpdate Existing El New System ` Not Req'd Fee Schedule Used For Cal ulatlon(Year), �,,,,.,,,,.,,,,,M,.m..,,,.,^ 111n,,.,,,,..,,,11e11^,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,
<br /> Reason Fire Alarm Required:
<br /> ROW 64.55 MF worksheet req'd for permit? LYes 0 No ,
<br /> Add'I ROW.64.55 does required prior to final? BYes JNo Additional Notes: •
<br /> VAi:UATION CALCULATION: Total$ f O, J
<br /> Approved By: e`r�i d1I4A.4- Date: /3 1q/VI
<br /> . PUI3LICWORKS 1 • '
<br /> Intake OK by: Date:
<br /> • Intake Comments: f FW Review&Worksheet Needed If: -1uN
<br /> • ,10sys Ow Eva!:
<br /> Additional Notes: N.tke 'I`. ✓ :. , l ClWater flSewer UStomi
<br /> /� ,EITraffic Mitigation Eva[,
<br /> Approved By: Date" �(�j /Z fQSife Work/Drainage(shownitriggered)
<br /> • q/C____
<br /> IDAddress Letter
<br /> ilIR DBI'ARTM) r T I
<br /> 1LIBackfowPreventionforhighhazard:
<br /> ((dental,medical,animals mortuary,
<br /> Separate 1 Deferred Submittals Required: Ihaspltal,supportive housing}
<br /> •
<br /> Fire Sprinklers ElFire Alarm ❑Other: i •
<br /> Additional Notes: El 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 /> El Review of As-Built Plans-NO FIRE FEE AND ❑is fully digital
<br /> Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder
<br /> ,Review/Inspection Scope-ADD FIRE FEE El Is In a Separate Green Folder(join with this folderfor permit issuance)
<br /> Approved By: M mt 2)A Date: �-12 02,y El Will be issued separately(Separate Green Foider,PW issued ahead of Bldg)
<br /> JPublic Works has-no scope on this permit---PW Not Required
<br /> ELEGTRICALIPLUMBING . Additional Notes:
<br /> •
<br /> Additional Notes: `
<br /> Approved By: Date: Completed ay: Date: ?'f- i 20.2,i,4
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