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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# "172 %��0/D <br /> BUILDING . PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:.�eSS Date: ti1al2N <br /> Intake Comments: Intake Comment• � <br /> Zone URLA <br /> 0 Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement Me•4rn,connec4r si-cee# <br /> Bldg/TI/Addn/Rem Size 60 kJNonresidential Use N/A <br /> Garage/Accessory Struct.Size Residential Use t vl+i-ca►n tly conclos <br /> Number of Stories I Proposed No.of Dwelling Units: N/A <br /> Basement EiNo DYes, Fin/Unfin Total No.of Dwelling Units: N/A <br /> Type of Construction V'g Planning/Landscape Inspection Required before Final? ❑Yes INo <br /> Occupancy Group R-... "In Lieu"Fee:Type: Amount$ t <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? No ['Yes ❑Shell Only Calculated: Credit: <br /> Code Year 2021 I2018 02015 ['Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ONew System ISINot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> - Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ONew System Not 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 /> Addi RCW.64.55 does required prior to final? ❑Yes IDNo Additional Notes: <br /> VALUATION CALCULATION: Total$ LQ�t 0 b <br /> Approved By: t -) Date:l/1 q /Zt-1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> • Intake Comments: PW Review&Worksheet Needed if: <br /> • , DSys Dev Eval: <br /> Additional Notes: OWater ❑Sewer ❑Storm <br /> lDTraffic Mitigation Eva! <br /> Approved By: C keo Date: (-c(,�,(,( !Mite Work/Drainage(shown/triggered) <br /> (, 1 <br /> DAddress Letter <br /> FIRE. DEPARTMENT . ,DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: .hospial,medicalt animals,mortuary, <br /> p q lhospita(,supportive housing) <br /> ❑Fire Sprinklers ['Fire Alarm ❑Other: 1 <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: 0 A Separate PW Permit is Required(Permit#:PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> C7 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:CsLibsoutNN Date: \—\,0-,24 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> NPublic Works has no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: No ?(1& 5(.(9106 <br /> Approved By: Date: Completed By: Date: I /' 1 to vL( <br />