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Intake &Approval Sheet (M ' PERMIT STAFF ONLY) f.LitT# c 07y' 0q0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone . // TE <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement • <br /> Bldg/TI/Addn/Rem Size I'/Z 7- Nonresidential Use r <br /> Garage/Accessory Struct.Size t—{ 1 I Residential Use <br /> Number of Stories •3 Proposed No.of Dwelling Units: / <br /> Basement AIo DYes, Fin 1 Unfin Total No.of Dwelling Units: / <br /> Type of Construction ' ._C PlanninglLandscape Inspection Required before Final? EYes ❑No <br /> Occupancy Group k(Z_C, "In Lieu"Fee:Type: Amount$ -- <br /> Occupancy Load 1f--C School Impact Fee: Total $ 1� �‘ <br /> Cert.of Occpuancy Required? ❑No Wes ❑Shell Only Calculated: /, 1 /c' Credit: - —. <br /> Code Year ❑ 0?1 NE2018 02015 DEverett School Dist d�Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing MINew System Mot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: --c-rt Gt KtT'S Park Impact Fee Total$ 3 3 3/ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): 07 02 f/ <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes IgNo <br /> Add'I RCW 64.55 does required prior to final? DYes tifNo Additional Notes: T J y a/- <br /> VALUATION CALCULATION: Total$ 312/9 66 41/I27 <br /> l q cV7 WC " D.'>S'Ci 6 V- Approved By: --Date: Z —/);Z y <br /> 3 a 6' .2 049 <br /> PUBLIC WORK$ <br /> Intake OK by: Date: <br /> 41J��t Intake Comments: IAWReview&Worksheet Needed if: <br /> QSys Dev Eval: <br /> Additional Notes: QWater QSewer OStorm <br /> 4.-5 <br /> ,QTraffic Mitigation Eval <br /> Approved By. Date: (Z(G i QSite Work/Drainage(shownitriggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT I OBackflow 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: gi 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 0 Is located in this folder <br /> 16-Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: (., �cs,L/h Date: 1 .-h�� ❑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 /> • <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> t <br /> Additional Notes: VW 6 Cillu WI '`AA is it y. <br /> Approved By: Date: Completed By: AV WAAA, Date: `'Z, ()71UL.3 <br />