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Intake &Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# B240�-- 0 1 D BUILDING I PLANNING Intake OK by: Date: -Z" Zo Intake OK by: /X Assign To: Date: 1Z-/L(o/ZLJ Intake Comments: Intake CommefftsK Zone vtZ 3 ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement lU /A, em Size Nonresidential Use e Residential Use INS I Number of Stories Proposed No.of Dwelling Units: Basement ! Jo ❑Yes, Fin/Unfin Total No. of Dwelling Units: Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes QNo Occupancy Group 7i "In Lieu"Fee:Type: Amount$CD Occupancy Load -7 [ School Impact Fee: Total $Q Cert.of Occpuancy Required? ©No es ❑Shell Only Calculated: © Credit: Code Year M021 ❑2018 112015 El Everett School Dist ❑Mukilteo School Dist Fire Sprinklers: ❑Update Existing Mew System Not Req'd Park Impact Fees for permits applied for after 1/112022: Reason Sprinklers Required: I Park Impact Fee Total (net due after credit for existing uses) Fire Alarm: ElJpdate Existing ew System El Not Req'd Fee Schedule Used For Calculation(Year): Reason Fire Alarm Required: t 2� �j( RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add'I RCW 64.55 dots required priorto final? ❑Yes []No Additional Notes: VALUATION CALCULATION: Total$ Approved By: Date: I Z ZCv All PUBLIC WORKS Intake OK by: Date: Intake Comments: IPWReview&Worksheet Needed if. VY 0Sys Dev Eva[: Additional Notes: II ❑Water ❑Sewer ❑Storm I ❑Traffic Mitigation Eva[ Approved By: L (�Q��_ , Date: ( f 0Site Work/Drainage(shown/triggered) (]Address Letter I FIRE DEPARTMENT ❑Backf ow Prevention for high hazard: Separate 1 Deferred Submittals Required: !(dental,medical,animals,mortuary, hospital,supportive housing) ❑Fire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: ❑This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder D4 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join With this folderfor permit issuance) Approved By: fAJDate: �— .3 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Public Works has no scope on this permit---PW Not Required ELECTRICAL/PLUMBING Additional Notes: n m t y qj v Additional Notes: ParlGln tot I Pv """' '" I Approved By: Date: lCompleted By. Date: oLi I 28