Laserfiche WebLink
Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# L- Jf O( 0(6 <br /> BUILDING . PLANNING <br /> Intake OK by: Date: intake OK by: Assign To: t A Date: 25 AA." VA <br /> Intake Comments: Intake Comments: <br /> Zone Pi <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement • <br /> Bldg/TI/Addn/Rem Size Nonresidential Use O+'r,434.44v" / C 106 <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories , Proposed No.of Dwelling Units: <br /> Basement iltiNo DYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction t� i Planning/Landscape Inspection Required before Final? DYes JNo <br /> Occupancy Group -/• - "In Lieu"Fee:Type: Amount$ 01'k <br /> Occupancy Load School impact Fee: Total $ ; P) 1 A <br /> Cert. of Occpuancy Required? lil No DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 I2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing❑New System nNot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ ",.44r I P (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing ❑New System lNot 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'I RCW.64.55 dots required prior to final? DYes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ /I1 on1' <br /> Approved By: 1, Cry.— Date: ZS J . 7024 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if:: <br /> • J ,y,�,, Q DSys Dev Eval: <br /> Additional Notes: 'no Gay F''r ti) OWater ❑Sewer ❑Storm <br /> eiM DTraffic Mitigation Eval <br /> Approved By: Ci 6 ,„ Date: Ili f).._) EDSite Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT OBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental, supportiveupt animals,houi mortuary, <br /> p q ihospital, housing) <br /> OFire Sprinklers ❑Fire Alarm ❑Other: I <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> . ❑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 ElIs fully digital <br /> ,, <br /> Mh'imai or No Fite 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 folderfor permit issuance) <br /> Approved By:NK .,k.int. Date: j _ 1`7 3 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> kJ 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:iMM4iAal7l diAt ikkj Date: 01 J2y 1210z1-1 <br />