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Intake & Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# �2 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 y <br /> Bldg/TI/Addn/Rem Size th Nonresidential Use <br /> Garage/Accessory Struct.Size +4 Residential Use <br /> Number of Stories �1- Proposed No. of Dwelling Units: <br /> Basement 51No ❑Yes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction IL Planning/Landscape Inspection Required before Final? R-YeS ❑No <br /> Occupancy Group `l. "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load J.- School Impact Fee: Total $ / <br /> Cert.of Occpuancy Required? ❑No ©Yes ❑Shell Only Calculated: //, 1 / — Credit: <br /> Code Year 1:12021 ❑2018 112015 ❑Everett School Dist fgMukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System ©Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 11R) (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System BNot Req'd Fee Schedule Used For Calculation(Year): -2 y2-3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes V No <br /> Add'I RCW 64.55 does required prior to final? ❑Yes EIN9 Additional Notes: <br /> VALUATION CALCULATION: Total $ �7 <br /> Approved By: cam— Date: —� <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: iPIN Review&Worksheet Needed if: <br /> ;;[]Sys Dev Eval <br /> a <br /> Additional Notes: <br /> i ❑Water ❑Sewer ❑Storm <br /> []Traffic Mitigation Eval <br /> Approved By: C� Date: l 7 I❑Site Work/Drainage(shown/triggered) <br /> r <br /> i❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: 1 4 <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-NO FIRE FEE AND ❑ Is fully digital <br /> El 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 with this folder for permit issuance) <br /> Approved By: ,r Date: l— ❑ 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: Completed By: 1 Date: ro <br />