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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) °ERMIT# 1 ' `TV,-) —01 o <br /> BUILDING P�.„NNiNG <br /> Intake OK by: Date: Intake OK by: Assign To: - .' Date: 3/7 / 'l <br /> Intake Comments: Intake Comments; <br /> Zone 11. `j <br /> 0 Make this a"W"Permit 0 SRC Required(Pre-Inup) Overlay/Agreement • 414 <br /> BIdgITI/Add em ize Zcit.1,-/0/-r r 3 o I Nonresidential Use <br /> Garage/Accessory Struct.Size / Residential Use lei <br /> Number of Stories Proposed No.of❑welling Units: +b <br /> Basement 131No DYes, Fin/Unfin Total No.of Dwelling Units: / ' <br /> Type of Construction Z p C Planning/Landscape Inspection Required before Final? DYes giNo ' <br /> Occupancy Group Z/>'I , "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load Zr-, School Impact Fee: Total $ /0 , <br /> 'Cert. of Occppancy Required? No [Iles OShell Only Calculated: / Credit: <br /> Code Year 02021 ,p12018 E12015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ONew System Liat Req'd Park Impact Fees for permits applied for after 11112022: <br /> -' Reason Sprinklers Required: Park impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm; DUpdate Existing❑New System KINot Req'd Fee Schedule Used For Cal ulatlon(Year): <br /> Reason Fire Alarm Required: � <br /> RCW 64.55 MF worksheet req'd for perrriit? DYes I n No 11. n e......1 ge•earob ry,f' <br /> Add'I RCW.64.55 dots required prior to final? DYes ONo Additional Notes: - r n e,,, ri°� 1' 'de Swill``r A-S. <br /> VALUATION CALCULATION: Total$ Olt O, JuJ pm) roof no-1- +o b.cr.ta( ze ` rA, 1.4.tb.+ <br /> Approved By: rt,o14 iLsvl__ Date: 340 y <br /> PUBLIC ViORKS • . <br /> Intake OK by: Date; <br /> Intake Comments: �PWRevietisr&WorksheetNeeded if. <br /> • ,QSys Dev Eval: <br /> Additional Notes: ❑Water LiSewer ❑Storm <br /> !1]Traffic Mitigation Eval <br /> Approved By: (L.zi/� Date: 3/��}/ jUSite Work/Drainage(shown/triggered) <br /> • /ji IQAddress Letter <br /> p <br /> FIRE DEPARTMENT f poackflow Prevention for high hazard: <br /> Separate Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> p q <br /> Se lhcsPtal supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: I . <br /> Additional Notes: Q This Permit Is Approved by Public Works ' <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#:PW ) • <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑Is fully digital <br /> LI Minimal or No Fire Scope-NO FIRE FEE D Is located In this folder <br /> ElReview/inspectionScope-ADDFIREFEE El Is in a Separate Green Folder(join with this folderfor permit Issuance) <br /> Approved By: Date: . r—1 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ►l •ublic Works has.no scope on this permit---PW Not Required <br /> ELEGTR(CAL/PLUMBING a dditional N <br /> Notes: <br /> Additional Notes: /ki-co <br /> if F>trlcc ow-'�if(/.9/i, 1 r'S I/i0 se'cf��e_ <br /> Approved By: Date: Completed (/ hill SG'Yl ✓ Date: D ilZe <br />