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<br /> Infake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# _
<br /> BUILDING PLANNING
<br /> Intake OK by: Date: Intake OK by: iU Assign To: 3QSS Date: 4 Iasi fr,.1.4
<br /> Intake Comments: Intake Comments:
<br /> Zone M V
<br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement Meireo,Pad.5-Meek-
<br /> Bldg/TI/Addn/Rem Size 3r Nonresidential Use a e1°sevvItte arecce es .S.. nfi
<br /> Garage/Accessory Struct.Size Residential Use irwiti-c. vn,ly,
<br /> Number of Stories , 4 hkft Proposed No.of Dwelling Units: —
<br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: "—
<br /> Type of Construction I Planning/Landscape Inspection Required before Final? ❑Yes IRNo
<br /> Occupancy Group Al 1 13 "In Lieu"Fee:Type: Amount$
<br /> Occupancy Load 16 h _ School Impact Fee: Total $ 0
<br /> Cert.of Occpuancy Required? ❑No ' Yes ❑Shell Only Calculated: Credit:
<br /> Code Year 02021 14`2018. 02015 _ ❑Everett School Dist ❑Mukilteo School Dist
<br /> Fire Sprinklers: ❑Update Existing INew System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022:
<br /> Reason Sprinklers Required: Park Impact Fee Total$6 (net due after credit for existing uses)
<br /> Fire Alarm: ❑Update Existing litiNew System ❑Not Req'd Fee Schedule Used For Calculation(Year):
<br /> Reason Fire Alarm Required:
<br /> RCW 64:55 MF worksheet req'd for permit? ❑Yes ja No
<br /> Add'I RCW 64.55 does required prior to final? ❑Yes MNo Additional Notes:
<br /> VALUATION CALCULATION: Total$ 12.E te-o p c2
<br /> 0(Ltt try Approved By: �= c�lu-J Date: Wit.//Z+-I
<br /> PUBLIC WORKS
<br /> Intake OK by: Date:
<br /> Intake Comments: ..,..,......,...,,....,,,.,.„,,.,.....,....„,...,.......,,,,,_.„,.........„,,.....�_.,,.,_„-.�..,,,.,,,
<br /> PW Review&Worksheet Needed if
<br /> IDSys Dev Eval:
<br /> ( OWater ❑Sewer ❑Storm
<br /> Additional Notes:
<br /> OTraffic Mitigation Eval
<br /> Approved B Date: It/1,Vill ❑Site Work/Drainage(shown/triggered)
<br /> DAddress Letter
<br /> FIRE DEPARTMENT x DBackflow Prevention for high hazard:
<br /> (dental,medical,animals,mortuary,
<br /> Separate/Deferred Submittals Required: hospital,supportive housing)
<br /> El Fire Sprinklers ❑Fire Alarm DOther:
<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 0 Is fully digital
<br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is Ideated in this folder
<br /> 'I Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance)
<br /> Approved By:X.5.rowyl Date: Z/V3.:.2y . ❑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 By: ate: ?.-3 i Zd?4 +
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