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IntakeApproval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# E�`Y ocQ' °--?S <br /> & � <br /> BUILDING . PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Vb► Date:S tAcidelt,24-01 <br /> Intake Comments: intake Comments: <br /> Zone MU. <br /> 0 Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement • Wit,tYd <br /> Bldg/Tl/Addn/Rem Size t3 to Nonresidential Use 'Go.! 1€4.J 4h41d1h..r.dt. <br /> 0. <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories i Proposed No.of Dwelling Units: <br /> Basement WINO CIYes n/Unfin Total No.of Dwelling Units: • <br /> Type of Construction '"�_- V a Planning/Landscape Inspection Required before Final? DYes 151No . <br /> Occupancy Group R �. "in Lieu"Fee:Type: Amount$ N LA <br /> Occupancy Load 15- School Impact Fee: Total $ 01 A <br /> Cert.of Occppancy Required? DNo 121Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 12018 ❑2015 [(Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:DUpdate Existing❑New System tilNot Req'd Park Impact Fees for permits applied for after 11112022: <br /> -• Reason Sprinklers Required: Park Impact Fee Total$ 4 IA (net due after credit for existing uses) . <br /> Fire Alarm: rUpdate Existing❑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 perrriit? DYes fil No . <br /> Add'l RCW 64.55 does required prior to final? EJYes No Additional Notes: <br /> VA[UATION CALCULATION: Total 3 aid`01A <br /> Approved By44,..: '", &*..V • <br /> Date: s M,✓L 4, <br /> • , <br /> . PUB.LIC WORKS . . <br /> IntakeOK by: Date441.1.1.1Mw„-.,„,,,1,,,„,.-..-.-..-.-will..,.,..,„.,..,,,,,llyry,.,,,,.,w.-.....w <br /> • Intake Comments: 113WReview&Worksheet Needed if: <br /> ,j DSys Dev Eval: <br /> Additional Notes: i fWater bSewer ❑Storm <br /> C144 ("$ 'Ai iixt, ,DTraffic Mitigation Eva! <br /> Approved Date: - (tbj' 4 —. (CDSite Work/Drainage(shownitriggered) <br /> a IQAddress Letter <br /> FillE DEPARTMENT ;DBackflow Prevention for high hazard: <br /> • `(dental,medical,animals,mortuary, <br /> Separate 1 Deferred Submittals Required: hospital,supportive housing) <br /> Fire Sprinklers ❑Fire Alarm ❑Other: l <br /> Additional Notes: El This Permit is Approved by Public Works • <br /> _ ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: El A Separate PW Permit is Required(Permit#:PW ) - <br /> El Review of As-Built Plans-NO FiRE FEE AND ❑is fully digital <br /> l Minimal or No Fire Scope-NO FIRE FEE ElIs located in this folder <br /> $Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: rQ cow'(1 Date:,,e a27r.2.</ , 1l 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 /> ELEGTR(CAL/PLUMBING dditional Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed By. •1 Date: <br />