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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 12fO( -.-t o6ti <br /> BUILDING . PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone U <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement • <br /> Bidg/TI/Addn/Rem Size Nonresidential Use ' Po ' --1w <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No DYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ❑N) <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ / <br /> Cert.of Occpuancy Required? lNo DYes ❑Shelf Only Calculated: Credit: <br /> Code Year ❑2021 1/42018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Flre Sprinklers: DUpdate Existing ONew System WNot 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 /> Fire Alarm: QUpdate Existing ❑New System pNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for permit? DYes ®No <br /> Add'l RCW 64.55 does required prior to final? DYes EINo diti n UL Notes. (��f 1 <br /> VALUATION CALCULATION: Total$ �� 5 � � �� `-1 1 h,11 <br /> Approved By: Date: <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if <br /> . ,1 QSys Dev Eval: <br /> • <br /> Additional Notes: '-/ • - <br /> 1 DWater ❑Sewer ❑Storm <br /> w �> W P(u, IOTraffic Mitigation Eval <br /> Approved By: C, `7 Q.w„.n Date: 1411 Zu £QSite Work/Drainage(shown/triggered) <br /> )]Address Letter <br /> FIRE.DEPARTMENT 3DBackflow Prevention for high hazard: <br /> • <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> ihospltal,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: I • <br /> Additional Notes: ❑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 /> ❑Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: ,)6-tj(.4)NeN Date: 1.,3(' 2J El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> '` 5iiPublic Works has.no scope on this permit--PW Not Required <br /> E_LEGTRICAL/PLUMBING . Additional Notes: <br /> Additional Notes: _ <br /> Approved By: Date: Completed By:Jtt y Date: 0// . /J2OZ1 <br />