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eC-D 1 OS -" OSS Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: 1:561 Date:t.)„„,, 24 Intake Comments: Intake Comments: Zone ❑Make this a"W"Permit ❑ SRC Required(Pre-lnsp) Overlay/Agreement Bldg ll do/Rem Size Nonresidential Use Garage/Accessory Struct.Size , 0 Residential Use S Number of Stories >f Proposed No.of Dwelling Units: Basement /SINo ❑Yes, Fin/Unfin Total No.of Dwelling Units: Type of Construction I e.G Planning/Landscape Inspection Required before Final? ❑Yes EgNo Occupancy Group I it "In Lieu"Fee:Type: Amount$ Occupancy Load I K,C., School Impact Fee: Total $ 'J Cert.of Occpuancy Required?allo ❑Yes ❑Shell Only Calculated: Credit: Code Year ❑2021 Q018. 02015 CI Everett School Dist ❑Mukilteo School Dist Fire Sprinklers: ['Update Existing ❑New System 'Not Req'd Park Impact Fees for permits appliedfor after 1/1/2022: Reason Sprinklers Required: Park Impact Fee Total$ 1J (net due after credit for existing uses) Fire Alarm: ❑Update Existing CI New System Mot Req'd Fee Schedule Used For Calculation(Year): Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes No Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: VALUATION CALCULATION: Total$32,6-040 OP&I13Ar . VAWkTfO). : 30/maid Approved B . _�_, ,(` Date: IZ JUkr io24 geAK)to)4 VWM*olu : �2506' "p40166 4532,54605 PUBLIC WORKS Intake OK by: Date: Intake Comments: IPW Review&Worksheet Needed if T6(i3 .15 Ct re y 5i o.. , Sys Dev Eval: �-Additional Notes: zr a I SSvN cc.. I]Water ❑SewerStorm CJ v c(c� f OTraffic Mitigation Eval Approved ByA,,`A,A) j Date:/3J014e2ZI./ or A i ` .. 1DSite Work/Drainage(shown/triggered) w 'tyv� �l r (2,S bccu, u - c" Il]Address Letter FIRE DEPARTMENT I DBackflow Prevention for high hazard: Separate/Deferred Submittals Required: !(dental,medical,animals,mortuary, (hospital,supportive housing) ❑Fire Sprinklers ['Fire Alarm ❑Other: I Additional Notes: RThis Permit is Approved by Public Work ❑See PW Review Worksheet and associated attached items Fire Dept.Fees: 'i A Separate PW Permit is Required(Permit#:PW 2 IOS- 032) ❑Review of As-Built Plans-NO FIRE FEE AND ,® Is fully digital ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder fain with this folder for permit issuance) Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) ❑ Public Works has no scope on this permit---PW Not Required _. ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: Completed By:A/47 7— Date: p6.l3-2,02.