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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 6 ,f b, b7 I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:1-4/.l/` Date: (o/I1/2-4I <br /> Intake Comments: Intake Comments: <br /> Zone 12j <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg ddn/Rem Size 413 Nonresidential Use \rig 1 <br /> Gara a/Accessory Struct.Size , Residential Use i <br /> Number of Stories f Proposed No.of Dwelling Units: <br /> _Basement gINo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> / 1 <br /> Type of Construction VR Planning/Landscape Inspection Required before Final? ❑Yes 10No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 1 School Impact Fee: Total $ I' <br /> ' Cert.of Occpuancy Required? ❑No DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist I <br /> Fire Sprinklers:14Update Existing Chew System ❑Not Req'd Park impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: pdate Existing El New System El Not Req'd . Fee Schedule Used For Ca culation(Year): Z62 + <br /> Reason Fire Alarm Required: 0,mday IoaAS -3 ew{cr- t,nw--6.04 a-) a,uk. "esku, w' <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ®No Cow a^a SkiViC�te.J si '��cr�F ce pw,ol 5 �S] Irus <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes �No Additional Notes:?"l 1- es 4S IS cv.d. fo%F.6. etvv -A e . <br /> 1 <br /> VALUATION CALCULATION: Total$ t(t b <br /> Approved By: $t Date: 6/2c1/pi <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if:: <br /> IOSys Dev Eval:IAdditional Notes: u ❑Water DSewer ['StormI OTraffic Mitigation Eval <br /> Approved By: ts,Q Date: 1/4 f I 14, I]Site WorkiDrainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Reid .(dental,medical,animals,mortuary, <br /> p q "hospital,supportive housing) <br /> ❑&ire Sprinklers ,Fire Alarm Other: <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑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 ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> I-Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: ` .t_A,‘ Date:( ,_..4/Wit,/ ❑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: Complete Date:(e-t-(,.-r2_,L4 <br />