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Intake&Approval Sheet •FOR PERMIT STAFF ONLY) illERMIT# �7tD- 1t 03 0 l
<br /> BUILDING . PLTNNiNG
<br /> Intake OK by: Date: Intake OK by: Assign To: 'D6 bate: II Mitigh. 4
<br /> Intake Comments: Intake Comments:
<br /> Zone Li-2
<br /> 0 Make this a"W"Permit ❑SRC Required(Pre•Insp) Overlay/Agreement kiToft tekup. rvit,r� M.
<br /> Bldg/II/Add lze 3kL1f_ Nonresidential Use h4644-6. I DN114.
<br /> Garage/Accessory Struct.Size [o (e2.v>�i,) Residential Use
<br /> Number of Stories fLe►M-ti.t, • Proposed No.of Dwelling Units: .
<br /> Basement NIo DYes, Fin I Unfin Total No.of Dwelling Units: •
<br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes 151No
<br /> Occupancy Group , "In Lieu"Fee:Type: Amount$ I.)IA
<br /> Occupancy Load 2.Y School Impact Fee: Total $ 01 h .
<br /> Cert.of Occppancy Required? 1No EiYes }Shell Only Calculated: Credit: .
<br /> Code Year 02021 rS018 02015 DEvereti School Dist LlMukilteo School Dist
<br /> Fire Sprinklers:NUpdate Existing DNew System Dlikiot Req'd Park Impact Fees for permits applied for after 11112022:
<br /> -• Reason Sprinkle Required: Yl (aYo f Park impact Fee Total$ r.)(A (net due after credit for existing uses) .
<br /> Fire Alarm: ElaUpdate Existing 0New System r&ot Req'd Fee Schedule Used For Calculation(Year);. „mM,mo.,,,,,•„um^mV p^ ^ten„..,,,, „n,.•.,.,•„ „n„•., ,,,,,,,
<br /> Reason Fire Alarm Required: k l in
<br /> RCW 64.55 MP worksheet req`d for permit? Yes Ea No .
<br /> Add'i RCW.64.55 does required prior to final? IJYes =4 No Additional Notes: •
<br /> VALUATION CALCULATION: Total$ $'7 2. ic),
<br /> Approved By:cej4:, , r Date: II Nt�rth 20 -
<br /> 14 ZD2a)
<br /> PUBLIC•WORKS
<br /> Intake OK by: Date.,,.,.,,,.,,, „.� . _,.. �„,,...,.,„ ••,,,,.,,•�,,..w,.,,
<br /> • Intake Comments: PWReview&Worksheet Needed if
<br /> • • ,r 1 D 6 6lc/! ,IDSys Dev Eval:
<br /> Additional Notes: `. /v /'f7(/�/h!� (GD(/i I DWater bSewer C(Storm
<br /> rl /� GDTraffic Mitigation Eva!
<br /> Approved By; Date: S / �� - �`' ?4 'Mite Work/Drainage(shownitriggered)
<br /> M/C.41 r0 i' I I:Address Letter
<br /> Fig DEPARTMENT �Z� S� /� I013ackllow Prevention for high hazard:
<br /> `� o Fe_ dental,medical,animals,mortuary,
<br /> Separate 1 Deferred Submittals Required: --r4 r_ kt, 65 i d'hospital,supportive housing)
<br /> ire Sprinklers `Fire Alarm ❑Other: t I •
<br /> Additional Notes: . El This Permit is Approved by Public Works •
<br /> . ❑See PW Review Worksheet and associated attached items
<br /> Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#:PW ) •
<br /> El Review of As-Built Plans-NO FiRE FEE AND 0 is fully digital
<br /> Ili`Minimal or No Fire Scope-NO FiRE FEE a Is located in this folder
<br /> .1l Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folderfor permit issuance)
<br /> Approved By: 334 �n Date: 325;24 El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg)
<br /> -JZ/ T-^z4 Public Works has.no scope on this permit—PW Not Required
<br /> ELECTRICAL/PLUMBING • dditional Notes:
<br /> Additional Notes:
<br /> Approved By: Date: Completed B 1) J/vT9$ Yi Date: 0 /6 q/7,o2),
<br /> f I`
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