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Intake & Approval Sheet OR PERMIT STAFF ONLY) =RMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone MU <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/ em ize Nonresidential Use D he1- y f? e.1(kiie <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group vit2 "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load • School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? j ',`No i Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 (12018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System IN"ot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: .,/Jy1 S�Y)iit A-fy�'vtic J Park Impact Fee Total$ (net due after credit for existing uses) <br /> ,W Fire Alarm: ❑Update Existing ❑New 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 in No <br /> yy <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes i_JNo Additional Notes: f� <br /> VALUATION CALCULATION: Total$ 'j[) ;t7 <br /> 2 •J✓ G rs�a Y� �\/ItO <br /> pproved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review 8 Worksheet Needed if: <br /> ,�� � ,/ ❑Sys Dev Eval: <br /> Additional Notes:- pp <br /> cyFt i + "t- g -)5 S't� OWater Chewer ❑Storm <br /> �1'4-2' ' ❑Traffic Mitigation Eval <br /> Approved By: (/" Date: (/U7rc&' DSite Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> �r�I }},,�� ihospital,supportive housing) <br /> AZtFire Sprinklers .YJFire Alarm ❑Other: <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 ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> 'Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: ,V>cOu J,A Date: \`— )y oZ 3 ❑ 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: ALL Z ( TEQlo2 • kJa Gt44NGE pF <br /> Additional Notes: U SF <br /> Approved By: Date: Completed By:A4 y � Q Date: it./I_202,01 <br />