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1. <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0671.-- .L? —OW <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 0 SRC Required (Pre-Insp) Overlay/Agreement • <br /> Bidg/TI/Addn/Rem Size t e7 Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories l • Proposed No.of Dwelling Units: . <br /> Basement ifINo ❑Yes, Fin/Untie Total No.of Dwelling Units: ' <br /> Type of Construction Ve, Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group ,C "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load �!S School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? ❑No Wes VIShell Only Calculated: Credit: <br /> Code Year 02021 02018 ❑2015 QEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing:New System ciiNot 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 ENew System ONot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for perrriit7 q No <br /> Add'I RCW.64.55 does required prior to final? Yes RI N. Additional Notes: <br /> VALUATION CALCULATION: Total 'At-' <br /> Approved By: 6/2 Date: 4/Lf I Zr3 <br /> ( i g71) 'Ik))) ) , , <br /> -! PUBLIC WORKS . <br /> C.-twit)�'m, M t f v.i. Intake OK by .� Date:€4740 iit) <br /> 11 LA � Intake Comments: AW Review&Worksheet Needed if• <br /> 1c4/( •tA"1 .., <br /> C0J, vvct 1]SysDevEval: <br /> AreeL, :Water ❑Sewertorm <br /> Additional Notes: <br /> c- . (.otNp o4 (.4-) No I'e-1-, rji ese.. <br /> �! i DTraffic Mitigation EvaI <br /> Approved By: C,/1 k � Date: 3(<j' o r � �t DSite •Work/Drainage(shown/triggered) <br /> v AJo Sr 4 ("JO VT joAddress Letter <br /> FIRE. DEPARTMENT l' Irk p e Sad i UBackflow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary, <br /> Separate I Deferred Submittals Required: Adie PIA,) !hospital,supportive housing) <br /> OFire Sprinklers WIFire Alarm ❑Other: ( <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 /> 0 Minimal or No Fire Scope-NO FIRE FEE 0 Is located In this folder <br /> -Review/Inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By; A),C-0fti,(-N Date: ,Z Ell Will be issued separately(Separate Green Folder,PW issued ahead ofBidg) <br /> 0 Public Works has.no scope on this permit--PW Not Required <br /> ELEGT.RICALJPLUMBING Additional Notes: <br /> Additional Notes: / <br /> Approved By: Date: Completed ByG=''r ate: 'l 7��i`l- <br />