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Intake &Approval Sheet m`FOR PERMIT STAFF ONLY) I=)ERM1T# .E9- C 4 —°`/ <br /> BUILDING . PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> intake Comments: Intake Comments: <br /> Zone <br /> ❑Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement • <br /> BIdg1Tl/Adds/Rem Size &S'/ Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories ( Proposed No.of Dwelling Units: . <br /> Basement 1No CIYes, Fin I Unfin Total No.of Dwelling Units: '_ <br /> Type of Construction \02 PlanninglLandscape Inspection Required before Final? ['Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load * f School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? DNo 1Yes giShell Only Calculated: Credit: <br /> Code Year 02021 02018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:❑Update Existing❑New System ICINot 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: ❑Update Existing JNew System ❑NotReq'd Fee Schedule Used For Calculation(Year):^ - n��„-.�., m - r <br /> .101111111.10111.11111111.11.1.1.1411.111111 <br /> Reason Fire Alarm Required: <br /> ROW 64.55 MF worksheet req'd for perrriit? ❑Yes Q No <br /> Add'!ROW.64.55 does required prior to final? IIYes J1No Additional Notes: <br /> VALUATION CALCULATION: Total$ 4).-�bls':a� <br /> Approved By: (f? Date:1 ki/Z-0.2--.1 <br /> , . <br /> PUBLIC WORKS . <br /> Intake OK by: 47 Date ,, ,,02-. ��,Za,,.,,, ,,,,,,..,,w,.,,...-,.. <br /> • Intake Comments: AW1?evPe►"u&WorksheetNeededif <br /> • Ccebin i meet A r_e n ys Dev Eva!: <br /> • <br /> Additional Notes: /vo C l'ucx r.�� LA—.- OWater DSewer AStorm <br /> L O P,j Ut-tm /M1elf'- t^mper v;.c v..) , '(—lTraffcMitigation Eva! <br /> Approved By: Q...,, tS atiq J\. Date: N I/ J l-'\ A10 s i 4-e--Luc eli. IDSife WorklDrainage(shown/triggered) <br /> • P f pQse I. Nv I IN IOAddress Letter <br /> FIRE DEPARTM>~NT 1DBaokflow Prevention for high hazard: <br /> • <br /> `(dental,medical,animals,mortuary, <br /> Separate 1 Deferred Submittals Required: [hospital,supportive housing) <br /> ❑Fire Sprinklers Fire Alarm DOther: ( • <br /> Additional Notes: P.. This Permit Is Approved by Public Works • <br /> . 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#:PW ) <br /> El Review of As-Built Plans-NO FIRE FEE AND ❑is fully digital <br /> LI Minimal or No Fire Scope-NO FIRE FEE a Is located in this folder <br /> ' Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder riola with this folderfor permit issuance) <br /> Approved By: V.,R..Jrb(A>Yl Date: .2O 'J/ 0 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 /> • ELEGTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:A,gir Se 4 Date: f 7�2c,-2621 <br /> . <br />