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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) PERMIT# � Si ' ^0 v--� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone i 2 <br /> ❑ Make this a"W"Permit ❑ SRCb Required (Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size / -1 3; k'ew jftf Nonresidential Use L' <br /> ara /Accessory Struct. Size Z(0 Residential Use �' <br /> Number of Stories Z Proposed No.of Dwelling Units: , <br /> Basement 'No DYes, Fin/Unfin Total No.of Dwelling Units: t <br /> Type of Construction L- Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group 7E( "In Lieu"Fee:Type: - Amount$ <br /> Occupancy Load 'PIK School Impact Fee: Total $ 6 .2 j'ic' <br /> Cert.of Occpuancy Required? ❑No %Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 142018 02015 ►'+ IFverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ONew System 4,Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: -/ Park Impact Fee Total$ y�. / (net due after credit for existing uses) <br /> �1tl Fire Alarm: DUpdate Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): :4 Q2 'J <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes No <br /> r <br /> Add]RCW 64.55 docs required prior to final? DYes No Additional Notes: ).!,? �,, ��l ih �/15 <br /> VALUATION CALCULATION: Total$ �('jrf 2 1-U C'''1:kt-f i,`S y 11G 17C`i,4,_ f h r[V'',l ✓ 4 <,,r A 1 <br /> r6 C I bb Z4 60 Approved By: • ( ,/ Date: ) "r., <br /> y x 4 / J 2� PUBLIC WORK <br /> I b Intake OK by: Date: \ )Ze l ZS <br /> K g 3 G F(5 Intake Comments: } �12W Review 8 Worksheet Needed if: <br /> 3P6u 3Z (2 0-Z- IOISys Dev Eval: <br /> Additional Notes: tt'R! F4-lA.e v- C iti doZt1 ItNater (ewer 4IStorm <br /> (l "x-d ur. Traffic Mitigation Eval <br /> Approved By: ( Date: "7-4y7 RI Site Work/Drainage(shown/triggered) <br /> IZAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: <br /> p !(dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: IN This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: W-A Separate PW Permit is Required(Permit#: PW(2-3)1-v\' ) <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 /> 0 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:\r cow,c Date: 1- I ,y ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 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:.-AtiAm yt .Aft01114,4 l Date: I7/ 'u0 J"('v5 <br />