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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#0Z1-A(M 2 <br /> BUILDING PLANNING <br /> '''f _ <br /> Intake OK by: Date: Intake OK by: Assign To:1 cL4t Date: iJi 'L'1 <br /> Intake Comments: Intake Comments: <br /> Zone /V <br /> ❑ Make this a"W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/ ize 7 6 L f 51_ Nonresidential Use t f p_ <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories j-f(x -Fit,‘,/ Proposed No. of Dwelling Units: 0 <br /> Basement ❑No ❑Yes , Fin/Unfin Total No. of Dwelling Units: 15* <br /> Type of Construction — ` Planning/Landscape Inspection Required before Final? ❑Yes ''No <br /> Occupancy Group `'- "In Lieu" Fee: Type: Amount$ <br /> Occupancy Load I 0' School Impact Fee: Total $ 0 <br /> Cert. of Occpuancy Required? ®-No ❑Yes Shell Only Calculated: / Credit: <br /> Code Year 02021 E.2018 1:12015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: Update Existing El New System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: ( tilt 1 LA-1 Park Impact Fee Total$. 0 (net due after credit for existing uses) <br /> Fire Alarm: in Update Existing ❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: V\"‘`} lI �` `I"1 <br /> . <br /> RCW 64.55 MF worksheet req'd for permit? :Yes No <br /> Add!RCW 64.55 dots required prior to final? ❑Yes No Additional Notes: o.--N-o t.A C«-e- "T.1. <br /> VALUATION CALCULATION: Total $ ( J (iv) <br /> Approved By: /1l f Date: 4//29/24/ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: IPW Review&Worksheet Needed if: <br /> lOSys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: ( / ,j Date: ) + (1)I)4 1❑Site Work/Drainage(shown/triggered) <br /> l//�� j❑Address Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: ,(dental,medical,animals, mortuary, <br /> hospital,supportive housing) <br /> -Fire Sprinklers Fire 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 ❑ Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: , 8 roc,/n Date: 5 -2. 0 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 /> 0, <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:T ) y�- ' �.. ;)/ Date: 4 4- r 1( 710Z'`1 <br />