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(2e V ((-' CICALS J__17 677--) <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 13 /r l°4� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:J _ Date: (o/Co/2t'l <br /> Intake Comments: Intake Comm s: <br /> Zone !-4 v <br /> ❑Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement L,on neci-cr•SkreeA- <br /> Bldg/Tl/Addn/Rem Size Nonresidential Use Q�� c e. <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories 1i Proposed No.of Dwelling Units: <br /> Basement ENo ❑Yes, Fin/Unfin Total No.of Dwelling Units: —"" <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes &No <br /> Occupancy Group g "In Lieu"Fee:Type: Amount$ U <br /> Occupancy Load School Impact Fee: Total $ d <br /> Cert. of Occpuancy Required? No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year ' 021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ONew System .Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers(Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: LLSUpdate Existing El New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required:RCW 64.55 MF worksheet req'd for permit? ❑Yes LW No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 15allo Additional Notes: <br /> VALUATION CALCULATION: Total$ 7 ?i©et_ <br /> Approved <br /> G� Date: to/ <br /> O Q PUBLIC WORKS <br /> 1.k � g Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> j OSys Dev Eva!: <br /> Water ❑Sewer ❑Storm <br /> Additional Notes: I <br /> 11:1Traffic Mitigation Eval <br /> Approved By: C .rst„4\ Date: _ 4:1/�� OSite Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT ;OBackflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: 'hospital,supportive housing) <br /> ❑Fire Sprinklers DFire Alarm ❑Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 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 ❑ Is located in this folder <br /> ®'Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: (..e.,e_, Date: - ❑ 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: Ako W S(.0Pj. 1 L L- ry Tt.Rt3Q— <br /> Additional Notes: <br /> Approved By: Date: Completed By �� /S .y,e Date: G E,_Zy >o2t-f <br />