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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ' Z' itS 0+-5 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone r (LU , <br /> ❑ Make this a"W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> BldgOf Addn/Rem Size 440 f <br /> I. Nonresidential Use C o(*zz Mai) <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No. of Dwelling Units: <br /> Basement lqNo ElYes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction I. C Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group �� "In Lieu" Fee:Type: Amount$ <br /> Occupancy Load 3.5 School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? ❑No ®Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 ❑2018 02015 El Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System L-Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ / (net due after credit for existing uses) <br /> Fire Alarm: 0 Update Existing ❑New System Not 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? ❑Yes ©No Addition I Note : <br /> VALUATION CALCULATION: Total$ ipi, 01. �� l.lJf11J/ - c 1v49/� <br /> Approved By: Date: <br /> , PUBLIC WORKS n <br /> Intake OK by: ��J Date: b Z1I 2-6 <br /> Intake Comments: 1PW Review&Worksheet Needed if. <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: L,r)sa,.,,..,_r• Date: 1> l( i‘5,11.3 ❑Site Work/Drainage(shown/triggered) <br /> ) 1 CI Address Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental, medical,animals,mortuary, <br /> Separate <br /> q :hospital,supportive housing) <br /> El Fire Sprinklers El Fire Alarm El Other: , <br /> Additional Notes: ❑ 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 0 Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ,Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: R trc,cein Date: 9!2 3 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> VI Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: 110 c,kAin . Ih J41AM to 4(/1i iz iavtiW\I4J g W 123 <br /> Approved By: Date: Completed'By: Date: <br />