Laserfiche WebLink
Intake &Approval Sheet W (FOR PERMIT STAFF ONLY) :PERMIT# `'� a0 l <br /> 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: f� Assign To: J 255 Date: I I/7 /Z,3j <br /> Intake Comments: Intake Comments <br /> Zone Q-1 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement NIM <br /> Beddn/Rem Size l,07to 5V.6- Nonresidential Use N/A <br /> Garage/Accessory Struct.Size — Residential Use S F R. <br /> Number of Stories — Proposed No.of Dwelling Units: N/A <br /> Basement ®No DYes, Fin/Unfin Total No.of Dwelling Units: 1 <br /> Type of Construction I0L Planning/Landscape Inspection Required before Final? ❑Yes ►No <br /> Occupancy Group IQL "In Lieu"Fee:Type: Amount$0 <br /> Occupancy Load I RE._ School Impact Fee: Total $ 0 <br /> Cert.of Occpuancy Required? ❑No DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 IA.2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ❑New System ENot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System PANot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required:RCW 64.55 MF worksheet req'd for permit? ❑ El Yes n.i No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 4NNo Additional Notes: <br /> VALUATION CALCULATION: Total$ tS it...- <br /> Approved By: Date: 11/7/23 <br /> PUBLIC WORKS <br /> Intake OK by: Date:41 0 I U2.,_� _ __ <br /> Intake Comments. <br /> PW Review&-Worksheet Needed if: - <br /> oket 'hi t(J i DSys Dev Eval: <br /> Additional Notes: m4Vl i ' "� <br /> - /W {M 1Water DSewer ❑Storm <br /> U,t AO at 4 / tf 1 Traffic Mitigation Eval <br /> Approved By: Date: 1� Ig 7 3 VW Ak1 , 'it l DSite Work/Drainage(shown/triggered) <br /> N 1 <br /> I❑Address Letter <br /> FIRE DEPARTMENT ' � 'DBackflow Prevention for high hazard: <br /> (dSeparate/Deferred Submittals Required: hospitntal,al, <br /> medical,r animals,mortuary, <br /> p q hospital,supportive housing) <br /> OFire 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 ❑ 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 Qoin with this folder for permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> WPublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: YtO cc �I�Mb �6 r <br /> Approved By: Date: Completed By• owl Date: I I MI <br /> jr2t� <br />