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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# \32- �I I -0�� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: ��2SS Date: IZ-/13/Z3 <br /> Intake Comments: Intake Comm&It <br /> Zone IA <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement A I A t ACA <br /> Bldg/TI/Addn/Rem Size .1'40 Nonresidential Use 'Pie aV J 'Incl a S'r i c\ <br /> Garage/Accessory Struct.Size Residential Use i\I/A <br /> Number of Stories ( Proposed No.of Dwelling Units: N.\A <br /> Basement ljElNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: N/A <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group F-1 "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No EYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 ri12018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: IYLUpdate Existing ❑New System .:slot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: oat/ p t=aZ_ g j Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System 14Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No <br /> Add'I RCW 64.55 docs required prior to final? ^ <br /> ❑Yes [_7No Additional Notes: <br /> VALUATION CALCULATION: Total$ M. c..19 0 O Pe1r C-tm p p l/ <br /> Approved By:AEA ( ,J) Date: I Z/13/2,4-- <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: loW Review&Worksheet Needed if: <br /> iDSys Dev Eval: <br /> Additional Notes: OWater ❑Sewer ❑Storm <br /> OTraffic Mitigation Eval <br /> Approved By: 6 k,,,,\ Date: t('At., <br /> DSite Work/Drainage(shown/triggered) <br /> fY� DAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dSeparate/Deferred Submittals Required: hospitntal,al, <br /> medical,animals,houi mortuary, <br /> p q hospital,supportive housing) <br /> ViFire Sprinklers Fire Alarm ❑Other: <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 El 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: fii...,N0Wy Date: *IA_ ,63 ❑ 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 /> • ELECTRICAL/PLUMBING. Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed B Date: iL fit('2 4- <br />