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Intake &Approval Sheet *OR PERMIT STAFF ONLY) ERMIT# Et9-11/67 "l <br /> BUILDING . PLANNING <br /> Intake OK by: Date: intake OK by: Assign To: Date: <br /> Intake Comments: intake Comments: <br /> Zone . <br /> 0 Make this a"W"Permit ❑SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size (17 Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement INo DYes, Fin/Unfin Total No.of Dwelling Units: ' <br /> Type of Construction V g PlanninglLandscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group e. . "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load ili School Impact Fee: Total $ <br /> Cert.of Occpuancy Require? DNo lYes KShell Only Calculated: Credit: <br /> Code Year 02021 02018 E12015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:❑Update Existing❑New System INNot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> -• Reason Sprinklers Required: Park impact Fee Total$ ' (net due after credit for exfsfing uses) . <br /> Fire Alarm: DUpdate Existing ill New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MP worksheet req'd for permit? QYes TA No <br /> Add'I RCW.64.65 does required prior to final? tJYes KIND Additional Notes: <br /> VALUATION CALCULATION: Total$ 91 6 ES _ <br /> Approved By: Date: giii/z0y/ <br /> AuJBI C WORKS • . <br /> Intake OK by: , Date ,,,,Q2„�2c.. 2o2y,,,„ ,.,„,.,w.„....,,.N <br /> Intake Comments: AW Review&WorksheetWorksheet Needed it <br /> • C� ►lon*cc;1 ., _ <br /> t� , ,E�Sys Dev Eval <br /> • <br /> itional Notes: <br /> �o /'lei' ��S�, 14 QWater DSewer)torm <br /> M" O P Co "p j P( ,r v jug , , <br /> LC�� IN P 3 DTraftic Mitigation Eval <br /> Approved By: (,t g �_` Date: j 0 d� . Alo 5 i-tC o rt I Mite Work/Drainage(shown/triggered) <br /> • 1 nc,opaxd. No P� II_(Address Letter <br /> FIRE DEPARTMONT _ 11 IDBackflow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary, <br /> q Separate 1 Deferred Submittals Required: [hospital,supportive housing) <br /> Fire Sprinklers ❑Fire Alarm ❑Other: 1 <br /> Additional Notes: .::lk 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 Q is fully digital <br /> Minimal or No Fire Scope-NO FIRE FEE ❑Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE a Is in a Separate Green Folder flornWith thrs folder for permit issuence) <br /> / <br /> Approved By: \1�1 c r,�).(N Date: c 7J/ El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> t���, 0 Public Works has-no scope on this permit--PW Not Required <br /> . ELECTRICAL/PLiUMBING Additional Notes: ' <br /> Additional Notes: <br /> Approved By: Date: Completed By:A y liet/. Date: 07-7 6-zo Zy <br />