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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# F42--L—f01 '06 <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone (AU <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bidg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction PlanninglLandscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "in Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? yjNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 1112018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ONew System 11Not 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: El Update Existing El 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? Dyes tEl No <br /> Add'I RCW 64.55 does required prior to final? ❑ I <br /> Yens N..lNo ••ditional Notes: / <br /> VALUATION CALCULATION: Total$ I i t y 0() 0 a 14a Dx Z- / l / c.fApproved By: Dte: <br /> aa <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if. <br /> • ,[['Sys Dev Eval: <br /> Additional Notes: V /t. sD ��� �II ❑Water ❑Sewer ❑Storm <br /> "Yi IOTraffic Mitigation Eval <br /> Approved By: C• Fyr , Date: 2/I' .M IUSite Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ;I�Backflow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary, <br /> Separate I Deferred Submittals Required: !hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑See 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 /> 14 Minimal or No Fire Scope NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor permit(ssuance) <br /> Approved By: N-)4-22(.4) ate: ❑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 /> • <br /> Additional Notes: / <br /> Approved By: Date: Completed By:A.hi/ /5 Date: V l!'3 L I 2,0 Z1 <br />