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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# Sc)-1 l9(2,- OCc <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To:,)eS,9 Date: 2./a/29, <br /> Intake Comments: intake Comma s: <br /> Zone N I <br /> ❑Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement A to 7 ACA <br /> Bldg/TI/Addn/Rem Size Nonresidential Use Hit* • .ncl4s4-c-ca.1 <br /> Garage/Accessory Struct.Size Residential Use — <br /> Number of Stories ( Proposed No.of Dwelling Units: <br /> Basement lNo OYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes .SNo <br /> Occupancy Group ( j (y� "In Lieu"Fee:Type: Amount$0 <br /> Occupancy Load �� School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? .No OYes ❑Shelf Only Calculated: Credit: <br /> Code Year 02021 lri2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:DUpdate Existing ONew System V Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing ONew System INot Req'd Fee Schedule Used For Calculation(Year):N <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes I71,No <br /> Add'I RCW.64.55 does required prior to final? DYes EgNo Additional Notes: <br /> VALUATION CALCULATION: Total$ `IIO t h 04 <br /> Approved BV-e4 Date:gig ilk + <br /> PUBLIC WORKS . <br /> Intake OK by: Date; <br /> Intake Comments: PW Review&Worksheet Needed it:1 -� <br /> • , OSys Dev Eval: <br /> ❑Water ❑Sewer ❑Storm <br /> Additional Notes: <br /> ,EITraffic Mitigation Eva! <br /> Approved By: e.„4.an ,Date: 6 5-1 (OSite Work/Drainage(shown/tr(ggered) <br /> 1DAddress Letter <br /> F <br /> FIREDEPARTMENT . JOBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> Ihospital,supportive housing) <br /> Fire Sprinklers ❑Fire Alarm DOther: I • <br /> Additional Notes: O 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 /> O Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> la Review/Inspection Scope-ADD FiRE FEE El <br /> 0 Is in a Separate Green Folder(loin with this foiderfor permit issuance) <br /> Approved By; \<,'� c.v yl Date: oz. -6, El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 7 MUblic Works has•no scope on this permit--PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed 13y Date:L /,shoo.4" <br />