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Intake &Approval Sheet t ? PERMIT STAFF ONLY) nlT# — 40(_ -Z <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 'mil <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Inup) Overlay/Agreement <br /> Bldg/TI/AddnlRem Size {lO 1 Nonresidential Use <br /> Garage/Accessory Struct. Size /tom/i" Residential Use Y- <br /> Number of Stories / Proposed No.of Dwelling Units: <br /> Basement NNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction I k_C Planning/Landscape Inspection Required before Final? DYes ONo <br /> Occupancy Group t "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load l (C School Impact Fee: Total $ / <br /> f <br /> Cert. of Occpuancy Required? No ' Yes ❑Il Shell Only Calculated: Credit: <br /> Code Year 02021 1162018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System KNot Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ • / (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing ❑New System Plot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes E No <br /> Add!RCW 64.55 docs required prior to final? DYes 156No Additional Notess:,\ , /^� 1 <br /> VALUATION CALCULATION: Total$_ L4 0 .0 5 ' )017(0,...QQ , /./V& <br /> pproved y: Date: <br /> (( <br /> t. l/1 (p __ PUBLIC WORKS <br /> lJ Intake OK by: Date: D I 1244242,4 <br /> ',v lA��t�nakc S/t„�, ,, . i 2pi5 Intake Comments: y, PWReview&WorksheetNeededif:: <br /> t� �. `� (LP'�- ✓�� v 10 1 13 � 1►Wi ❑Sys Dev Eval: <br /> Additional Notes: , C/ <br /> WmA-Gr" l -i ❑Water OSewer ['Storm <br /> / "'1 DTraffic Mitigation Eval <br /> Approved By Date: �j,/2/(I J'i IDSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT . ❑Backflow Prevention for high hazard: <br /> (dSeparate/Deferred Submittals Required: hospitantal,l, <br /> medical,r animals,ui mortuary, <br /> p q hospital,supportive housing) <br /> OFire Sprinklers DFire Alarm ❑Other: i <br /> �{ <br /> Additional Notes: 1N This Permit is Approved by Public Works <br /> KSee PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 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 Corn with this folder for permit issuance) <br /> Approved By: Date: ❑ 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:A/ (A ,W,(/Yyvi,nh Date: 0 i1 ZIPI2 2-4 <br />