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Intake & Approval Sheet <br />)R PERMIT STAFF ONLY <br />RMIT # � 1�% -3 /� Vq(( <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />TA . t -f- <br />Garage/Accessory Struct. Size <br />rA vP P-OD M <br />Number of Stories <br />Y <br />Basement <br />KNo ❑Yes , Fin / Unfin <br />Type of Construction <br />l (LC <br />Occupancy Group <br />9— C <br />Occupancy Load <br />R- C <br />Cert. of Occpuancy Required? <br />ZNo ❑Yes ❑Shell Only <br />Code Year 102021 02018 112015 <br />Fire Sprinklers: El Update Existing ❑New System SNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ,Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br />Add'I RCW. 64.55 docs required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $ P� D• y <br />1�-sF AaDrrto� <br />c4r of q-rAi n <br />Additional Notes: JAMEOVO V41 Lavtwtf'NTC <br />Approved By: Date: I 2,9J'TTI <br />L Z <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: SS Date: <br />Intake Comm : <br />Zone <br />Overlay/Agreement <br />M /A <br />Nonresidential Use <br />N/A <br />Residential Use <br />51= R <br />Proposed No. of Dwelling Units: <br />M//a <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes ONo <br />"In Lieu" Fee: Type: Amount $ C7 <br />School Impact Fee: Total $ 0 <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ 0 (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: te:1 2 2 <br />U <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Review & Worksheef Needed if: <br />I DSys Dev Eva[ <br />II� ❑Water ❑Sewer ❑Storm <br />111Traffic Mitigation Eval <br />I <br />iUSite Work/Drainage (shownitriggered) <br />IlAddress Letter <br />IElBackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />!hospital, supportive housing) <br />e <br />This Permit is Approved by Public Works <br />a See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder( join with thisfolderfor permitissuance) <br />❑ 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 />Additional Notes: t*f-orYKw a4-er -% t 6- r?&F <br />y%1 (aror� S'Ca-(e-J <br />Completed By: Date: <br />v/ V <br />