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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#B24-0(0 -01 I <br /> BUILDING PLANNING <br /> !Make OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone LI 2, <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-lnsp) Overlay/Agreement s"I -/ c ISIA e - <br /> /'s IA- / He GA 15�evc.cr�rs--f Pctv,r f1'Gd <br /> Bldg/TI/Addn/Rem Size Nonresidential Use DC-6 f c , <br /> Garage/Accessory Struct.Size , Residential Use t.11 A <br /> Number of Stories / Proposed No.of Dwelling Units: NIA <br /> Basement ❑No ❑Yes, F" /Unfin Total No.of Dwelling Units: (J1q <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ViNo <br /> Occupancy Group "In Lieu"Fee:Type: __"- Amount$_ — <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? •No DYes ❑Shell Only Calculated: - Credit: <br /> Code Year 02021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Up.: e Existing ONew System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinkler- -equired: Park Impact Fee Total$ �w <br /> (net due after credit for existing uses) <br /> Fire Alarm: ■Update Existing El New System ❑Not Req'. Fee Schedule Used For Calculation(Year): / <br /> Reason , re Alarm Required: <br /> RCW .4.55 MF worksheet req'd for permit? DYes 0 N i <br /> •'WI RCW 64.55 docs required prior to final? DYes ■N Additional Notes: <br /> VALUATION CALCULATION: Total$ n bq z <br /> Approved By: p.,,.,_ - Date: a Co t2 G t z.c 2..,4 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: /� f [PW Review&Worksheet Needed if: <br /> 11 - 4V((2Aled 'Pk) 1DSys Dev Eval: <br /> Additional Notes: GO0441 S OWater ❑Sewer ❑Storm <br /> F- DTrafFc Mitigation Eval <br /> Approved B Date: G LD z Site Work/Drainage(shown/triggered) <br /> / ❑Address Letter <br /> FIRE DEPARTMENT 11:1Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> /hospital,supportive housing) <br /> ❑Fire 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(join with this folder for permit issuance) <br /> Approved By:N, A_,1 Date:6- (( G/ . ❑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 B . i ©AA gm Date: (0 h 1 170 <br />