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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# &I/41-0 tp2 <br /> BUILDING PLANNING <br /> J <br /> Intake OK by: Date: Intake OK by: G/ Assign To: e SS Date:$1$/.Z4 <br /> Intake Comments: Intake Comments: <br /> Zone H• <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement A T.A , A C A <br /> BIdelAddn/Rem Size <` c�� •— �fp Nonresidential Use µl h =Ind%)sir i a„, <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories 1 Proposed No.of Dwelling Units: -- <br /> Basement fi3No ❑Yess, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes INo <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ 0 <br /> Occupancy Load School Impact Fee: Total $ 0 <br /> Cert.of Occpuancy Required? ' No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 'I42021 02018. 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing [New System (*Not 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: El Update Existing El New System Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes QNo <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes I'No Additional Notes: <br /> VALUATION CALCULATION: Total$ 11141 01540 <br /> Approved By: ,. Date:8/8 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if <br /> I0Sys Dev Eval: <br /> Additional Notes: <br /> ❑Water ❑Sewer ❑Storm <br /> I ClTraffic Mitigation Eval <br /> Approved By: UV Q„�,�tig, Date: `Q � �� I OSite Work/Drainage(shown/triggered) <br /> [[JJ ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dentaSeparate/Deferred Submittals Required: hospital, <br /> l medical,or animals,houi mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: I <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 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 /> al-Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: �(awn Date: g-5 .24 ❑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 Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: 10(I/ ) Date: 01 1 tot 1207,1-1 <br />