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Intake & Approval Sheet 11, (FOR PERMIT STAFF ONLY) 0 PERMIT# 82 HUlo 8 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: , Assign To: 3e.. ,> Date: 514 ZH <br /> Intake Comments: Intake Comments: <br /> Zone R -Z <br /> ❑ Make this a"W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement S't3euva.11c pc for ' _ <br /> Bldg/TI/Addn> em ize /S 9 Nonresidential Use — <br /> Garage/Accessory Struct. Size ----- Residential Use JF 2 ,AOL) 1 4-p 1e__x <br /> Number of Stories nj Proposed No. of Dwelling Units: Do pl'-K -3 Si'z + Z AO L.: <br /> Basement ❑No n Yes , Fin Unfin) Total No. of Dwelling Units: '7 <br /> Type of Construction * 0.'2 V Planning/Landscape Inspection Required before Final? ❑Yes DNo <br /> Occupancy Group r — - "In Lieu" Fee: Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? ❑No Wes ❑Shell Only Calculated: Credit: <br /> Code Year p2021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑update 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 El New System FiNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? Yes 0 No <br /> Add'I RCW 64.55 docs required prior to final? P-Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ 0/000 <br /> (/ Approved By: T "m - : (1 Date: ki9 I3124- <br /> 1 I <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: I PW Review&Worksheet Needed if: <br /> 141Sys Dev Eval:litt-3t:tyklif'e\ <br /> iI)J Q�p /,/-}, Water l�]Sewer Storm <br /> Additional Notes: V1 61 'mil• ‘tilt <br /> Traffic Mitigation Eval-n 14,-c pl,k, <br /> Approved By: _ 7.7 <br /> / /7 Date: / �(� ��y- OSite Work/Drainage(shown/triggered) <br /> ` L / 6 �{/�livi;n\tetvc CO `P/�"(�0�( � IWAddress Letter-q/j4 I&Ll.A <br /> FIRE DEPARTMENT l�` I '�Backflow Prevention for high hazard: <br /> Se crate/Deferred Submittals Re wired: � C1k P ���I Ib ;(dental,medical,animals, mortuary, <br /> p q _ :hospital,supportive housing)��rfnfi <br /> Fire Sprinklers PFlre Alarm ❑Other: 10 'J4e\ . <br /> Additional Notes: tsiThis Permit is Approved by Public Works <br /> / 1St PW Review Worksheet and associated attached items <br /> V <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 /> E,, Minimal or No Fire Scope-NO FIRE FEE ils located in this folder <br /> IEd Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: 'f1 CGw� Date: 6-1`_2L( 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ELECTRICAL/PLUMBING additional Notes: <br /> 1R G <br /> Additional Notes: ArP G-gwIt1 um) la,kiv‘ ) iti,,, �� <br /> Approved By: Date: Completed BY: —Batt %I LLI1 <br />