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6. <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1- (9 f 0 I 05 <br /> BUILDING . PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone k) <br /> 0 Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> BIdgiTl/Addn/Rem Size Nonresidential Use � riafl <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: ' _ <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ �--"" <br /> Cert.of Occpuancy Required? lo DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 E212018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing Chew System ffiNot Req'd Park Impact Fees for permits applied for after 11112022: <br /> -- Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> rrtt�� <br /> Fire Alarm: DUpdate Existing DNew System IiNot Req'd Fee Schedule Used For Calculation(Year): M,^y^^ .,,,.,,,,, <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ®No <br /> Add'I RCW..64.55 does required prior to final? ❑Yes IENo Additional Notes: K. n ' <br /> VALUATION CALCULATION: Total$ v-i t ic On �o'' J `c K. �!t 1k ' . <br /> Approved By: Date: <br /> , <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> • <br /> • OWater OSewer DStorm <br /> Additional Notes: Kcjv iiitmi <br /> QTraffic Mitigation Eva[ <br /> ( <br /> Approved By: 7,, ,N. Date: lit/ .. Q <br /> (, Site Workiorainage(shown/triggered) <br /> Y DAddress Letter <br /> FIRE DEPARTMENT ,DBackfiow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: i . <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 /> tit 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 foiderfor permit issuance) <br /> Approved By: Na>seD Lox\ Date: )-130 -24 ❑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 /> • ELEGTRICAL/PLUMBING • Additional Notes: <br /> • <br /> Additional Notes: _ <br /> Approved By: Date: Completed By:'ht y /s4 Q„ Date: ©f/�f 17o z y <br /> S :V r <br />