Laserfiche WebLink
Intake &Approval Sheet I(T. PERMIT STAFF ONLY) I =T#t 0%'—�57 <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 7/ <br /> 0 Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement • <br /> Bldg/TI/Addn/Rem Size t 17iq Nonresidential Use <br /> Garage/Accessory Struct.Size 4 1 Residential Use <br /> Number of Stories 3 Proposed No.of Dwelling Units: 1 <br /> Basement ViNo DYes, Fin/Unfin Total No.of Dwelling Units: I <br /> Type of Construction I Planning/Landscape Inspection Required before Final? 11Yes ❑No <br /> Occupancy Group e-C, "In Lieu"Fee:Type: Amount$ - <br /> i�Occupancy Load CC School Impact Fee: Total $ J/ g/ <br /> Cert.of Occpuancy Required? DNo Yes ❑Shell Only Calculated: // I'/ Credit: — " <br /> Code Year D2 11 02018 02015 DEverett School Dist �Mukilteo School Dist <br /> Fire Sprinklers: Update Existing •L_INew system ❑Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> _. Reason Sprinklers Required: 5+ UM13 Park Impact Fee Total$ ,1,j)/ (net due after credit for for existing uses) <br /> • Fire Alarm: ❑Update Existing❑New System F4Not Req'd Fee Schedule Used For Calculation(Year); 0 2_/ 111 1 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes VI No <br /> Add'I RCW.64.55 docs required prior to final? ❑Yes Vi No Additional Notes: 3/1/ I ' f jut buy 4-/ <rrn, �/ <br /> VALUATION CALCULATION: Total$ ( r d o <br /> 112, 4 166 -c2159 i6ed--' lS03Le Approved By: 1-�i'Z„�". Date: �,2 •rJ 2 <br /> Li(( 6`I' a6, '(-( PUBLIC.. . .. . . <br /> 3,„).,-fr 4c-t' — .2- ctee_ <br /> Intake OK by: Date.,.,., ,..,,,.,,.,,,,_..._. <br /> Intake Comments: [PW Review&Worksheet Needed if: <br /> • It 10Sys Dev Eval: <br /> Additional Notes: Water ❑Sewer ❑Storm <br /> 1_—,Tra: <br /> MitigationEvalApproved By: Date: I7/2,1 jSite Work/Drainage(shown/triggered) <br /> IOAddress Letter <br /> FIRE DEPARTMENT ICDBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: Ihospitl,medical,r animals,mortuary, <br /> p q hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: 14 This Permit is Approved by Public Works <br /> . 0 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 0 Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: R-,:,/, Date: i' D Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope on this permit---PW Not Required <br /> • ELEGTRICAL/PLUMBING - . Additional Notes:• - <br /> Additional Notes: y r ,c[ �� 4I '�itA;i t, <br /> Approved By: Date: Completed B���t. 1'kW MA1 Date: 12I0I2.23 <br /> L <br />