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yeAr-6gLi_c94-L.b.- ''-frefu • dam, - Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 324 Z l O3 055 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: 'Oh Date: IZ 411+ Intake Comments: Intake Comments: Zone TZ,..'J ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement Bldg/TI/Addn/Rem Size Nonresidential Use Garage/Accessory Struct.Size , Residential Use A c 1t Number of Stories Proposed No.of Dwelling Units: Basement ❑No ❑Yes Fin/Unfin Total No.of Dwelling Units: 1 Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes $No Occupancy Group "In Lieu"Fee:Type: Amount$ r1/A Occupancy Load School Impact Fee: Total $ N 1 A Cert.of Occpuancy Required? ❑No ❑Yes ❑Shell Only Calculated: Credit: Code Year 02021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: Reason Sprinklers Required: Park Impact Fee Total$ t� I A (net due after credit for existing uses) Fire Alarm: ❑Update Existing New System Not 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$ Approved By:C"_- 1 ). ram` Date: IZ Av u4t' So PUBLIC WORKS J " Intake OK by: Date: Intake Comments: IPW Review&Worksheet Needed if: ©Sys Dev Eval: Additional Notes: I OWater ❑Sewer ❑Storm l OTraffic Mitigation Eval Approved By: Date: l]Site Work/Drainage(shown/triggered) I❑Address Letter FIRE DEPARTMENT (DBackflow Prevention for high hazard: (dental,medical,animals,mortuary, Separate/Deferred Submittals Required: :hospital,supportive housing) ❑Fire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: ❑This Permit is Approved by Public Works ❑See PW Review Worksheet and associated attached items Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#: PW ❑ 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 0 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) Approved By: f6 J,n Date: 0-' .c2, ❑ 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: Date: