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• <br /> 411 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#52-103 091 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone —1 <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-lnsp) Overlay/Agreement l" <br /> Bldg/TIIAdd Size (05f. Nonresidential Use / <br /> Garage/Accessory Struct.Size , R.ey.,.,...,1.‘ Residential Use IVik.af ilt�h1,mf (Si-12- <br /> Number of Stories sk,s,�,‘1/1Proposed No.of Dwelling Units: ` J <br /> Basement Vivo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction ZK Planning/Landscape Inspection Required before Final? ❑Yes dNo <br /> Occupancy Group ../ , 1 _u"Fee:Type: N(R Amount$ )-(fs <br /> Occupancy Load L9. ^' , .hool Impact Fee: Total $ N( <br /> Cert.of Occpuancy Required? ► No VaYes ❑Shell Only Calculated: N I Ps Credit: of A <br /> Code Year ■2021 02018. 02015 El Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System q-Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ N I tr (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): 4J I/>, <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add'I RCW 64.55 dots required prior to final? Dyes No Additional Notes: <br /> VALUATION CALCULATION: Total$ •" � <br /> t <br /> Approved By: )_ �1,..---- Date: (scpi i-,{ !z o z4 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> OSys Dev Eval: <br /> Additional Notes: /� tt(" / I OWater ❑Sewer ❑Storm <br /> 1 I <br /> (]Traffic Mitigation Eval <br /> Approved By: 14, Date: b N l ()/I 1 A IDSite Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate I Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> =hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 See 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 ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> 0-Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder with this folder for permit issuance) <br /> Approved By:(. 6•I 0E,,ti l Date: 3-/9,.,a4 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 1!,Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING 'd.itional Notes: <br /> Additional Notes: t eV t 1ST"/( Ci!/aiay " ��d,..c�-2_ <br /> Approved By: Date: Completed By: Date: /%3 f 7i'G^( 9pl <br />