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©A/4(Afre ASP. <br /> Intake &Approval Sheet . (FOR PERMIT STAFF ONLY) • PERMIT# E;211.1°(7.44=1"14:2 <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 ❑ SRC Required(Pre-Insp) Overlay/Agreement • <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning!Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 0201.8 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑No <br /> Add'I RCW 64.55 docs required prior to final? Dyes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: <br /> )PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> `['Sys Dev Eval: <br /> Additional Notes: OWater ❑Sewer OStorm <br /> €DTraffic Mitigation Eval <br /> Approved By: Date: DSite Work/Drainage(shown/triggered) <br /> [ Address Letter <br /> FIRE DEPARTMENT ;DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,pr animals,mortuary, <br /> p q hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: 0 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 /> ❑ 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 /> ❑ Review/Inspection Scope ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date: ❑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 /> •. ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: ���,.-- Date: �-c Completed By: Date: <br />