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P4ft) E12-01FOR OFFICE USE ONLY PERMIT# 111 .iejr;�!: %) <br /> BUILDING PLANNING <br /> Bldg/TI/Addn/Rem Size Zoning Classification <br /> Garage Size Overlay/Agreement <br /> VALUATION Nonresidential Use <br /> Number of Stories Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupant Load Total No.of Dwelling Units: <br /> Basement No— Yes_ Fin / Unfin Landscape or Planning Inspection <br /> Type of Construction needed before final? Yes No <br /> Existing Sprinkler System? Yes_ No Unk Planning Inspector: <br /> Fire Sprinkler Required Yes No_ Phone#: <br /> Reason Approved by: Date: <br /> Existing Fire Alarm Yes No Unk Historic Approved by: Date: <br /> Fire Alarm Required Yes_ No_ School Mitigation Reqd? Yes_ No— <br /> Reason Everett School Dist Mukilteo School Dist <br /> Enclosure Law Applies Yes_ #of Net New Units: <br /> Deferred Submittal Req'd Yes_ No Calculated School Impact Fee: <br /> Approved by: Date: School Impact Fee Credit: <br /> Comments: Total School Impact Fee Owed: <br /> Comments: <br /> Intake OK by:_a_041M vloirc AA)/ Aoe, <br /> Intake OK by:lab reMeinjor J <br /> lJ PUBLIC WORKS - <br /> FEES INTAKE: Checked By: k$ Date: /ZS-/fo <br /> Plan Check Fee Comments: ttJILL //Ced ;Piro. Craw, fe am, <br /> Building Permit C11,9ineck- S1,?0Wf u" the Pand is Si24d Oi <br /> Surcharge High Hazard Sites(Dental,Medical,Animals,Mortuary,etc-Review for RPBA)t <br /> Additional Plan Check 0 Public Works/Sys Dev/Traffic Mit./RPBA-NOT REQUIRED <br /> Ni <br /> -o <br /> Plumbing Fee 0 Route for Public Works Review(bldg folder,PW Worksheet) •- <br /> Mechanical Fee a( Public Works Permit-Concurrent Review(separate green folder)-2 V <br /> Ping Bldg Review Fee PW REVIEW: PW Reviewer: -- Date: i/R /2H - <br /> Water FeePW Permit Approved-PW i(012,--011-1 <br /> Sewer Fee 'See PW Review Worksheet <br /> Systems Dev.Fee 0 PW Permit Not Required <br /> Traffic Mitigation Fee <br /> Public Works Fee FIRE DEPARTMENT <br /> School Mitigation Fee Update/New Sprinklers Yes No— Existing Bldg. <br /> Update/New Detection Yes_ No_ Existing Bldg. <br /> Update/New Chemical Yes_ No— Existing Bldg. <br /> Update/New Fire Service Yes_ No_ Existing Bldg. <br /> Approved by: Date: <br /> Comments: <br />