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Intake & Approval Sheet 'OR PERMIT STAFF ONLY) •RMIT# r �N\-- (29, <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: b i Assign To: )es Date: It J ZI 'Z3 <br /> Intake Comments: Intake Comments: <br /> Zone M U <br /> ❑ Make this a"W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement Nte{-ro,ped• s rreci- <br /> Bldg/TI/Addn/Rem Size �+- 41O)OW qt Nonresidential Use OFF i.c.2,S <br /> Garage/Accessory Struct. Size -- Residential Use N/A <br /> ��Number of Stories 1, 3, di/ 7 j 0-seProposed No. of Dwelling Units: N/A <br /> Basement ❑No Yes, Fin/ nfi Total No.of Dwelling Units: 1.1/fk <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group K /S "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load l A School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? RJNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year ❑2021 W2018 122015 El Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: IZUpdate Existing ❑New 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: <br /> RCW 64.55 MF worksheet req'd for permit? Oyes 5] No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes VNo Additional Notes:neea t'd C- e.ck c 11-1,1 Ke\secJi Or <br /> VALUATION CALCULATION: Total$c2c2i7a7T 677 t03,rv"� )' O J <br /> Approved By: Date: k 7 N-ci---- <br /> _ ?, <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: 1 PWReview&Worksheet Needed if: <br /> I❑Sys Dev Eva!: <br /> Additional Notes: DWater DSewer DStorm <br /> 1❑Traffic Mitigation Eva! <br /> Approved By: G ar' Date: 3//J/AH I❑Site Work/Drainage(shown/triggered) <br /> E❑Address Letter <br /> FIRE DEPARTMENT j❑Backflow Prevention for high hazard: <br /> j(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: (hospital,supportive housing) <br /> to Sprinklers EfFire Alarm ❑Other: ' <br /> Additional Notes: ❑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 /> ❑ 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: : e,r-c›[fin Date: 12_S--;,z3 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> giPublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: i`i b Pk) '6le p k <br /> Approved By: Date: Completed 6 `�/ Date: ,YG 1i 1 -k <br />