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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2-361-pS2. <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: t0 Assign To: •Jess Date:B//5/23 <br /> Intake Comments: Intake Comments: <br /> Zone _) I <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement Al A,AGA,Pcur,e 1-ieta x40, <br /> Bldg/TI/Addn/Rem Size II Nonresidential Use prro css; Faber cwm n 0.-(Asi...bA� <br /> Garage/Accessory Struct. Size Residential Use Ns,A <br /> Number of Stories Proposed No.of Dwelling Units: N/R <br /> Basement KINo ❑Yes , Fin/Unfin Total No. of Dwelling Units: !.t/A <br /> Type of Construction E $ Planning/Landscape Inspection Required before Final? ❑Yes ,EirNo <br /> Occupancy Group r 1- "In Lieu" Fee:Type: Amount$ 0 <br /> Occupancy Load School Impact Fee: Total $ 0 <br /> Cert. of Occpuancy Required? IZNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1:12021 ®2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing El New System EINot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ J (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing El New System ©Not Req'd Fee Schedule Used For Calculation(Year): 23 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? El Yes ® No <br /> Add'i RCW 64.55 docs required prior to final? ❑Yes @No Additional Notes: <br /> VALUATION CALCULATION: Total $ 'ty p0l p Qa <br /> Approved By: z' Date: S/i5f23 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: IPW Review&Worksheet Needed if: <br /> /a'vt 7 1-19. fl4Sys Dev Eval: <br /> Additional Notes: <br /> ist thulm M ! ❑Water ❑Sewer Storm <br /> I❑Traffic Mitigation Eval <br /> Approved By: (,6.44_,,"4...i, Date: it i S 114�� Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Separate <br /> q hospital,supportive housing) <br /> El Fire Sprinklers El Fire Alarm DOther: <br /> Additional Notes: tiziThis Permit is Approved by Public Works <br /> e e ew ass . e i e s <br /> Fire Dept. Fees: A Separate PW Permit is Required(Permit#: PW 2?j05'610 5 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> gi Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: K W h Date:g.,a/023 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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: AA,o,t,(,, j j, 3Date: 0 lit) Ob 2.024) <br />