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i 40 Intake &Approval Sheet 411° (FOR PERMIT STAFF ONLY PERMIT#02/21-0( o24 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To:,'401,(^ Date: 7/1IZdZ4( Intake Comments: Intake Comments: Zone --- ❑Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement Bldg/TI/Addn/Rem Size (7 Z t '116S3 Nonresidential Use Garage/Accessory Struct.Size , U00 (1) Residential Use . Number of Stories I Proposed No.of Dwelling Units: - 4M-1 Basement '.No ❑Yes, Fin I Unfin Total No.of Dwelling Units: ( ( g w%-ti��T) Type of Construction 2-L Planning/Landscape Inspection Required before Final? ❑Yes,lNo Occupancy Group ..../ "In Lieu"Fee:Type: Amount$ Occupancy Load School Impact Fee: Total $ 11 i(4 Cert.of Occpuancy Required?1441 o ❑Yes ❑Shell Only Calculated: Credit: Code Year U 021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist Fire Sprinklers: ❑Update Existing ONew System EFINot Req'd Park Impact Fees for permits applied for after 1/1/2022: Reason Sprinklers Required: Park Impact Fee Total$ M k (net due after credit for existing uses) Fire Alarm: El Update Existing ❑New System 1lNot Req'd Fee Schedule Used For Calculation(Year): Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes 1 No Add`i RCW 64.55 docs required prior to final? ❑Yes Additional Notes: VALUATION CALCULATION: Total$4,t6 Approved By: /c-2 Date: '7�Io/2C2.1f PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Review&Worksheet Needed if: / �� I❑Sys Dev Eval: Additional Notes: I C - C4 1t Iti fiy f 1 OWater El Sewer ❑Storm LI / IDTraffic Mitigation Eval Approved By: Date: �ifry Site Work/Drainage(shown/triggered) 111 IDAddress Letter FIRE DEPARTMENT ❑Backflow Prevention for high hazard: (dental,medical,animals,mortuary, Separate/Deferred Submittals Required: hospital,supportive housing) OFire Sprinklers OFire Alarm DOther: I Additional Notes: ❑This Permit is Approved by Public Works 0 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 id-Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder ❑Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) Approved By: /wri Date: 7 e. '. 0 Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) `� if Public Works has no scope on this permit---PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: Completed By:itAkt, 4 t-z " Date: 0 0 Iy I 2 ZL_{