Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY • <br /> PP ERMIT# 32310- 0 3 5 <br /> BUILDING ' PLANNING <br /> Intake OK by: Date: Intake OK by: //, Assign To: Jess Date: I I. Z.1)23 <br /> Intake Comments: Intake Commen <br /> Zone M <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement Aila,. AG(k <br /> BldgfTl/Addn/Rem Size 12175 Nonresidential Use 12-el\g,00S/Places o4 worship <br /> Garage/Accessory Struct.Size Residential Use )J/A <br /> Number of Stories ) Proposed No.of Dwelling Units: (,If1 <br /> Basement inNo DYes , Fin/Unfin Total No.of Dwelling Units: ►`!/A <br /> Type of Construction Ill Q Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group 3 "In Lieu"Fee:Type: Amount$0 <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? No DYes ❑Shell Only Calculated: Credit: <br /> Code Year ❑2021 V12018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System SNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ O (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System 1:Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes El No <br /> Add'I RCW 64.55 docs required prior to final? DYes EtNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 0,06 <br /> Approved By: . Date: I.I /Z 1)2 3 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> OSys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> IDTraffic Mitigation Eval <br /> Approved By: ( ,\.„, Date: (lI 1 V t z4 ❑Site Work/Drainage(shown/triggered) <br /> 1111'OAddress Letter <br /> I <br /> FIRE DEPARTMENT ?DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: :(dental,medical,or animals,houi mortuary, <br /> p q hospital,supportive housing) <br /> Fire Sprinklers> Fire Alarm DOther: <br /> Additional Notes: ❑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 0 Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> la Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By:� c - ,7V- Date: ,2—s-2-� 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> �"� 1 IVPUbliC Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:AeA for TT Date: t D/,' / Z 3 <br />