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Intake &Approval Sheet PERMIT STAFF ONLY) IT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ✓1/1S <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size ("7-al" Nonresidential Use — <br /> Garage/Accessory Struct.Size l--C 11 Residential Use <br /> Number of Stories 3 Proposed No.of Dwelling Units: <br /> Basement Z1No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction \‘ .C, Planning/Landscape Inspection Required before Final? 4'Yes ❑No • <br /> Occupancy Group 1 g-C • "In Lieu"Fee:Type: '—,, Amount$ — <br /> Occupancy Load (QC. School Impact Fee: Total $ / Xy,6 <br /> Cert.of Occpuancy Required? ❑No Eyes ❑Shell Only Calculated: //)er l6 Credit: ,61— <br /> Code Year 02021 y12018 ❑2015 ❑Everett School Dist , 2 Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing New System ❑Not Req'd Park Impact Fees for permitsit applied for after 1/112022: <br /> Reason Sprinklers Required: ` 11 -0• u Park Impact Fee Total$ 33/` (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System INot Req'd Fee Schedule Used For Calculation(Year): O2 62 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? oyes ix No <br /> Add'I RCW.64.55 docs required prior to final? _J/�❑Yeses���plo Additional Notes: gol�,SGr 4-1 �/y, <br /> VALUATION CALCULATION: Total$ 3/rZ `�` <br /> � <br /> ! Approved By:7 - ',--tA--Date: 2 ../..3=Ly <br /> ( 7� 7 >4 (6‘ age ; 6 e,2 <br /> Li( 6 y to 30c( PUBLIC WORK$ <br /> 3oZ 644 0 L 0 Intake OK by: Date: <br /> -- Intake Comments: IPW Review&Worksheet Needed if:. 3 a.?, l L7Sys Dev Eval: <br /> Additional Notes: I ❑Water ❑Sewer ❑Storm <br /> I DTraffic Mitigation Eval <br /> Approved B . Date: t-. /z(f 2 !Mite Work/Drainage(shown/triggered) <br /> jDAddress Letter <br /> FIRE DEPARTMENT lDBackflow Prevention for high hazard: <br /> /Deferred Submittals Required: '(dental,medical,animals,mortuary, <br /> Separate <br /> q hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: ! <br /> Additional Notes: VI 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 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: A 6e:761J yl Date: _l Q .,23 El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> v ❑Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: no , 1' i vl "rtiviGini 2 <br /> Approved By: Date: Completed By: fi titeAsJ4 , Date: V2,It0 120/A <br /> i <br />