Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 3 (( _0 5 — <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-lnsp) Overlay/Agreement <br /> BIdg/TI/Add Rem Size 1W j o V Lm'S Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories 3 Proposed No.of Dwelling Units: <br /> Basement 171No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction -*( Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group 7/iu, "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load tip(. School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No mYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 ixi2018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ONew System [,Not 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 Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required:RCW 64.55 MF worksheet req'd for permit? ❑ .lT�Yes ial No <br /> Add'I RCW 64.55 docs required prior to final? ❑YesNo Additional Notes: <br /> VALUATION CALCULATION: Total$ y (7 t (ail" <br /> Approved By: (Ji, Date: a/zc;/Z0,Z. <br /> PUBLIC WORKS <br /> Intake OK by: Date: 11\z7.\'2'O1 )) <br /> Intake Commen . I PW Review&Worksheet Needed if: <br /> p fu �l 6�v IICO f ' Q6 I OSys Dev Eval: <br /> Additional Notes: AppYU✓BLOC -t -/P I ❑ ❑ ❑ <br /> Water Sewer Storm <br /> 4 <br /> ado. x°� ;DTraffic Mitigation Eval <br /> Approved By: if bate: ( ���r , � ,(� � OSite Work/Drainage(shown/triggered) <br /> losprikvkr YJvt)� `.17 ; Address Letter <br /> YJv u I <br /> FIRE DEPARTMENT � ?(�y '�PiYI'IWt.Q }p =DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: MZ}y O'S"r"—v f� Ihospitl,mupical,animals mortuary, <br /> p q U-,,'1 �,,, �,�, hospi al,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: '1 ''�J N.1 erikd 1 `U 100-642 11-I13I2b7-3 . <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items _ <br /> Fire Dept.Fees: RI A Separate PW Permit is Required(Permit#:PW 2)1,1'61O5 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND p Is fully digital <br /> Minimal or No Fire Scope-NO FIRE FEE El Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: V..,v., (No W,Date: 12.—S.....a23 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:AVAMitl,l Date: 121 13'I'2,t2,6 <br />