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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# -�/ 4 °o?- 0 j/7 <br /> PP 7 <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-Inep) Overlay/Agreement <br /> Bldg/Ti/Addn/Rem Size rte Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories ! • Proposed No.of Dwelling Units: <br /> Basement $7.1No DYes, Fin/Unfin Total No.of Dwelling Units: ' <br /> Type of Construction 11 Planning/Landscape Inspection Required before Final? ❑Yes ONe <br /> Occupancy Group r "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 4 S1 School impact Fee: Total $ <br /> Cert.of Occppancy Required? ONo 1Yes dShell Only Calculated: Credit: <br /> Code Year E12021 fid2018 E12015 QEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:DUpdate Existing❑New System I Not Req'd Park Impact fees for permits applied for after 111/2022: <br /> -• Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) • <br /> Fire Alarm: DUpdate Existing RINew System ONot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 0 No . <br /> Add'I RCW 64.55 does required prior to final? DYes Io Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: LI/4/z i'4 <br /> g il X ')— 7- ( —g <br /> PUBLIC WORKS <br /> clip t G .1414 <br /> f , 14 Intake OK by:'" <br /> Intake Comments: Date:W oa ry (Pt ,+,f <br /> .t�`� � IiReview&Worksheet Needed if:�`" 80 /f -J '46ys Dev Eval: <br /> 56) <br /> Additional Notes: L /► � CC Additional <br /> ❑Sewer Storm <br /> Q �M P�i:.�' o lV N� f� ,G� ;[(Traffic Mitigation Eva! <br /> Approved By: CA., e b ,Date: 3/('' PC t 114 a(•G� ICISite Work/Drainage(shown/triggered) <br /> • q�, d 0 IDAddress Letter <br /> FIIEI~ DEPARTMENT / v /y , tstd iLiBackflow Prevention for high hazard: <br /> • <br /> Separate 1 Deferred Submittals Required: ((dental,medical,animals,mortuary, <br /> q [hospital,supportive housing) <br /> Fire Sprinklers Fire Alarm ❑Other: A/0 PA I <br /> Additional Notes: 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 ❑Is fully digital <br /> LI Minimal or No Fire Scope-NO FIRE FEE 0 k Is located in this folder <br /> gi-Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(ioin with this folder for permitIssuance) <br /> Approved By:V, Date: .,., '� . Q Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Q Public Works has.no scope on this permit---PW Not Required <br /> ELEGTR!CALtPLUMBING • Additional Notes: <br /> • <br /> Additional Notes: i <br /> Approved By: Date: Completed Aj4 i► - II/ Date:emIR0 Cd°aL't <br />