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Intake &Approval Sheet •OR PERMIT STAFF ONLY) •RMIT#3 cP- 1( --0694.7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone UT-5 <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Ap I/Addn/Rem Size Z P'1! f goo yiajL , Nonresidential Use <br /> Garage/Accessory Struct.Size ® , Residential Use w " <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement ligNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction lifitPlanning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group (, "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load ''�/P(, School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? KI,No ❑Yes OShell Only Calculated: Credit: <br /> Code Year 02021 M2018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing P.New System ❑Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: _ '7, ryym Park Impact Fee Total$ • / (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing PINew System Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: A-po- 7 jeatr ; <br /> RCW 64.55 MF worksheet req'd for permit? El Yes i' No <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes ►:,No ''onal Notes: ? 1 <br /> VALUATION CALCULATION: Total$ 3Sn,9 o I�.�l 1//l li� I` ( /0/2(`� <br /> rov d By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: 0 Date: 11 I 11 ilbV3 <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> �'"""+ PU4 ' ICISys Dev Eval: <br /> Additional Notes:4Y'flf I`ll ' ASV(yam ❑Water ❑Sewer ❑Storm <br /> -pp/ / � '� i 't! Nat io resk ��. /�C.(/ I•a J`IJ DTraffic Mitigation Eval <br /> Approved By: q/cDate: 1 I Site Work/Drainage(shown/triggered) <br /> /Z� ( a "' `v' 4"" I DAddress Letter <br /> FIRE DEPARTMENT DBackflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Separate <br /> q :hospital,supportive housing) <br /> ❑Fire 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 ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date: 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> %Public Works has no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: /�, /' �,„ , ow <br /> Additional Notes: C/1'eM-c A4{IWI �/�/0V111 `I-yA'i"Q - DUNlIg - <br /> Approved By: Date: Completed 131 jleAlVIDYL/ Date: C I Ill 1/7Z g <br />