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(12416eA) 5 firrrk . --C:CaeiS
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<br /> Intake &Approval Sheet (FOR PERMITSTAFF ONLY) ERMIT# �t -o e
<br /> BUILDING . PLANNING
<br /> intake OK by: Date: Intake OK by: Assign To: Date:
<br /> intake Comments: Intake Comments:
<br /> Zone VT-5
<br /> 0 Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement .
<br /> J Bldg/TI/Addn/Rem Size col( Nonresidential Use
<br /> Garage/Accessory Struct.Size Residential Use P-1+
<br /> Number of Stories t. Proposed No.of Dwelling Units:
<br /> Basement igNo DYes, Fin/Unfin Total No.of Dwelling Units: •
<br /> Type of Construction V,L Planning/Landscape Inspection Required before Final? DYes ❑No
<br /> Occupancy Group 1)-L, , "In Lieu"Fee:Type: Amount$
<br /> Occupancy Load Ciz-LJ School Impact Fee: Total $
<br /> Cert.of Ocepuancy Required? ❑No l$Yes ❑Shell Only Calculated: Credit:
<br /> Code Year D2021018 E12015 DEverett School Dist ❑Mukilteo School Dist
<br /> Fire Sprinklers:DUpdate Existing I New System El Not Req'd Park Impact Fees for permits applied for after 111/2022:
<br /> Reason Sprinklers Required: Park Impact Fee Total$ ' i (net due after credit for existing uses) •
<br /> Fire Alarm: DUpdate Existing WiNew System DNot Req'd Fee Schedule Used For Calculation(Year):
<br /> Reason Fire Alarm Required:
<br /> RCW 64.55 MF worksheet req'd for permit? DYes It No .
<br /> Add'l RCW.64.55 does required prior to final? DYes o Additional Notes:
<br /> VALUATION CALCULATION: Total$ Qrn/y Y41(L0 a11 / .
<br /> INsizsD, l
<br /> r 0S0D Approved By: Date:
<br /> PUBLICWORKS
<br /> IntakeOK by: Date:,,..1,.,,,,,,,,1, ...W.-. ,..,,4.,,„,,,,,,,,,,,,,,,,,,,,,,,,4,,.,,..,,„,..
<br /> • Intake Comments: AWreview&Worksheet Needed if
<br /> • ,❑Sys Dev Eval: '
<br /> • ❑Water USewer ❑Storm
<br /> Additional Notes: '
<br /> (DTraffic Mitigation Eval
<br /> ,,
<br /> Approved By: etge ,,,,,+v l Date: a/,), /'a.1,t , IQSite Work/Drainage(shown/triggered)• IDAddre5s Letter
<br /> FIRE DEPARTN1 NT I DBackflow Prevention for high hazard:
<br /> (dental,medical,animals,mortuary,
<br /> Separate/Deferred Submittals Required: !hospital,supportive housing)
<br /> DFire Sprinklers ❑Fire Alarm DOther: I •
<br /> Additional Notes: . D This Permit is Approved by Public Works '
<br /> . El See PW Review Worksheet and associated attached items
<br /> Fire Dept.Fees: D A Separate PW Permit is Required(Permit#:PW ) •
<br /> D Review of As-Built Plans-NO FiRE FEE AND ❑ Is fully digital
<br /> D Minimal or No Fire Scope-NO FIRE FEE ❑Is located In this folder
<br /> gi.Review Scope-ADD FIRE FEE Cl is in a Separate Green Folder(join with this folderfor permit issuance)
<br /> Approved By s,Exti(. c.)h Date: —6, -;,24' D Will be issued separately(Separate Green Folder,PW issued ahead of Bldg)
<br /> VI Public Works has-no scope on this permit---PW Not Required
<br /> ELECTRICAL/PLUMBING Additional Notes: .
<br /> Additiona!Notes: Ma.A/147CONIAN
<br /> Approved By: Date: Completed By: VAMITihy�/Yh�1n.�ate: 0210(AA 2.11 .
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