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III <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) 0 PERMIT# 2''"QO4--- <br /> BUILDING PLANNING <br /> Intake OK by: (4Date: Intake OK by: if Assign To: Jess Date: 4/I2/v4 <br /> Intake Comments: Intake Comments: <br /> Zone MU <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement Metro <br /> -- - <br /> 55--7q-- <br /> Nonresidential Use. O-ccLCe <br /> Garage/Accessory Struct.Size Residential Use — <br /> Number of Stories Proposed No.of Dwelling Units: — <br /> Basement cAioo ❑Yes, Fin/Unfin Total No.of Dwelling Units: — <br /> Type of Construction VA Planning/Landscape Inspection Required before Final? ❑Yes igNo <br /> Occupancy Group 13. "In Lieu"Fee:Type: Amount$ Q <br /> Occupancy Load School Impact Fee: Total $ 0 <br /> Cert.of Occpuancy Required? 1-1-No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 54f321 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: Ipdate Existing ❑New System ONot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ O (net due after credit for existing uses) <br /> Fire Alarm: 1044pdate Existing ❑New System El Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: r <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes s-No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $ <br /> Approved By: Date: 41l Z/V-f <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: I PW Review&Worksheet Needed if: <br /> Osys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> OTraffic Mitigation Eval <br /> Approved By: . Date: s / 2t ( Site Work/Drainage(shown/triggered) <br /> IIIJJJ� ElAddress Letter <br /> FIRE DEPARTMENT lDBackflow Prevention for high hazard: <br /> (dental,Separate/Deferred Submittals Required: hospital,medical,pr animals,mortuary, <br /> p q supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is fully digital <br /> ❑ 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:\g( Date: 4 �d/ 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 dditional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By. ,tiyyM, Date:oitti l Nisi <br />