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Cali\ N24/1/ I theCt k <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# j22.3( t -01 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:i Assign To:JQSS Date: 3Jzo/Z 4 <br /> Intake Comments: Intake Comments: <br /> Zone M U <br /> ❑Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement Side„dattc, Pedesrr(an sk'cee-r <br /> BId�Addn/Rem Size "1 3)60 Nonresidential Use feizx.•1 sales &ser.rCceS <br /> Garage/Accessory Struct.Size , 1444-,4=1,44-.. Residential Use <br /> Number of Stories (l.( vt..til.. _ Proposed No.of Dwelling Units: , <br /> Basement ' No, /❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction v 6 Planning/Landscape Inspection Required before Final? ❑Yes i31'No <br /> Occupancy Group 1\1 "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 3 T School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑Nor-Yffyye��s ❑Shell Only Calculated: Credit: <br /> Code Year 02021 P1✓018. 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System INNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System 'IPNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes yly No <br /> Add'I RCW 64.55 docs required prior to final? oyes mlNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 'ZA1 .0`' <br /> Approved By: <br /> y Date:3/2ptZy ` <br /> PUBLIC WORKS <br /> Intake OK by: Date: ' <br /> Intake Comments: 1PwRew&Worksheet Needed if: <br /> F DSys Dev Eval: <br /> i ❑Water ❑Sewer OStorm <br /> Additional Notes: t <br /> i DTraffic Mitigation Eval <br /> Approved By: Date: �T ( IDSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT I DBackflow 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: 0 This Permit is Approved by Public Works <br /> 0 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 /> ❑ 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: Date: 0 Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> tifPublic Works has no scope on this permit---PW Not Required <br /> _. ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:124 1 j Date: 0 3)1112.0L <br />