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Intake &Approval Sheet PERMIT STAFF ONLY) -I1IT#
<br /> BUILDING PLANNING
<br /> Intake OK by: Date: Intake OK by: Assign To: Date:
<br /> Intake Comments: Intake Comments:
<br /> Zone /L Z3
<br /> ❑ Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement
<br /> BldglTI/Addn/Rem Size 1.-Z-3' Nonresidential Use
<br /> Garage/Accessory Struct.Size Jil i Residential Use y
<br /> Number of Stories 9 Proposed No.of Dwelling Units: i
<br /> Basement MNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: I
<br /> Type of Construction 1 f-C Planning/Landscape Inspection Required before Final? Yes ❑No •
<br /> Occupancy Group 1 C "In Lieu"Fee:Type: Amount$
<br /> Occupancy Load I School Impact Fee: Total $ 11/�7G
<br /> Cert.of Occpuancy Required? ❑No M`Yes ❑Shell Only Calculated: //l'/6' Credit: ••�
<br /> Code Year ❑20 1 12018 02015 ❑Everett School Dist 1,21mukilteo School Dist
<br /> Fire Sprinklers: ❑Update Existing NIA New System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022:
<br /> - Reason Sprinklers Required: tt--���vi S+ t Iv, is Park Impact Fee Total$ 33>� (net due after credit for existing uses)
<br /> _1• Fire Alarm: ❑Update Existing I. New System Wlot Req'd Fee Schedule Used For Calculation(Year);,,,,,,,,,,,,,,,,,,,c ,02 0„ T _,1 '1 .,,,...,,,,,,,,...,,.....,.,.,,,,,,,,
<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 171No Additional Notes: L3 ,j t: J N .e y a I %f74,6'N,"p
<br /> VALUATION CALCULATION: Total$ o
<br /> 31 S-,n3Y . Approved By: 2-�---- Date: 4 - /c-02 `V
<br /> f
<br /> (7R7 A- t66 a;gd�e� .
<br /> I PUBLIC•WORKS
<br /> LtI( x6 �r --a61 — (
<br /> 3a4_6'cl� f a Lt V Intake OK by: Date
<br /> f Intake Comments: PW Review&Worksheet Needed if:
<br /> ❑Sys Dev Eval:
<br /> ❑Water ❑Sewer OStorm
<br /> Additional Notes: '
<br /> f DTraffic Mitigation Eval
<br /> A
<br /> Approved By: 1, iii Date: :I c J Zil I OSite Work/Drainage(shown/triggered)
<br /> f / I DAddress Letter
<br /> FIRE DEPARTMENT I OBackflow Prevention for high hazard:
<br /> - (dental,Separate/Deferred Submittals Required: hospital,supportivemupioat animals,mortuary,
<br /> p q housing)
<br /> OFire Sprinklers ❑Fire Alarm ❑Other:
<br /> Additional Notes: V.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 /> ❑ 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 foiderfor permit issuance)
<br /> Approved By:,�,G,(YjW n Date: t0_,..-1 fl-2 ❑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: NI 4(' I� 't 4 t
<br /> Approved By: Date: Completed By. at )Date: 1' )13 2023
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