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Intake & Approval Sheet (FOR PERMIT STAFF ONL PERMIT#V t0 02M <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone Gi/2.3 <br /> ❑ Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size tkii Nonresidential Use <br /> Garage/Accessory Struct. Size 01,1 Residential Use V <br /> Number of Stories -).. Proposed No.of Dwelling Units: l 9 <br /> Basement /ZINo Oyes , Fin/Unfin Total No. of Dwelling Units: /f <br /> Type of Construction Sg..L Planning/Landscape Inspection Required before Final? lgYes ❑No <br /> Occupancy Group .-CA.> "In Lieu" Fee:Type: -- Amount$ — <br /> Occupancy Load L. School Impact Fee: Total $ //, ,f:/ .• <br /> Cert.of Occpuancy Required? ❑No ®Yes ❑Shell Only Calculated: /// e'+/6 Credit: 153'.— - <br /> Code Year 02021 I7018 02015 El Everett School Dist I!—^FMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System WNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ I JiG (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing ❑New System SNOt Req'd Fee Schedule Used For Calculation(Year): ZerZ 3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes E No <br /> Add'I RCW 64.55 docs required prior to final? DYes QNo Additional Notes: <br /> VALUATION CALCULATION: Total $ tt <br /> 5,0 t;1Sv, Approved By:j_��ie" Date: /,) _2( „z 3 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: [PW Review&Worksheet Needed if: <br /> `E❑Sys Dev Eval: <br /> Additional Notes: I :Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> ( 1 Approved By: (C., _� Date: �9 L IDS <br /> ite Work/Drainage(shown/triggered) <br /> I I❑Address Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> I(dental, medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: !hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: • <br /> Additional Notes: his Permit is Approved by Public Works <br /> ee 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 0 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:BP 347 Date:/c -27-2_5 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By`''�ce/ G � Date: /O/i 0 1i.Z 3 <br />