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Intake & Approval Sheet (FOR PERMIT STAFF ONLI) PERMIT# C4 --OS ( <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 � vtt,t,`LV-Z fap V 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 1112021 ❑2018. 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing ❑New System El 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? []Yes []No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> 20 � Approved By: Date: <br /> t- �J• PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review d Worksheet Needed if <br /> ❑Sys Dev Eval: <br /> sa z <br /> []Water ❑Sewer []Storm <br /> Additional Notes: <br /> lv�<< V <br /> t14^1 11#1 U 7 fh // ❑Traffic Mitigation Eval <br /> Approved By: Date: []Site WorkfDrainage(shovm/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT 11 Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: / (dental,medical,animals,mortuary,hospital,supportive housing) <br /> []Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: ❑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-NeFIRE FEE AND ❑ Is fully digital. <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a.Separate Green Folder(join vdth this folderfor permit Issuance) <br /> Approved By: Date: ❑W ill be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> ❑ Publ'oworks has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additi al Notes: <br /> Additional Notes: <br /> A proved By: Date: C mpleted By: Date: <br />