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intake &Approval Sheet OR PERMIT STAFF ONLY) •MIT# TL(d fr 0 (S <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 /> BIdgiTl/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑N es, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Y "In <br /> Inspection Required before Final? DYes ❑No <br /> Occupancy Group ������C((CCC In Lieu Fee:Type: Amount$ <br /> Occupancy Load School impact Fee: Total $ <br /> Cert.of Occpuancy Required? 0No DYes DSheli Only Calculated: Credit: <br /> Code Year 02021 1712018 E12015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers:ElUpdate Existing DNew System Mot Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing❑New System 12Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes No <br /> Add'I RCW.64.55 docs required prior to final? DYes No Additional Notes: <br /> VALUATION CALCULATION: Total$ FQ r7a <br /> Approved By: Z.r� Date: ��/ <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> • ,❑Sys Dev Eval: <br /> Additional Notes: oe. iG I3'�---- C1Water OSewer ❑Storm <br /> l I❑Traffic Mitigation Eval <br /> Approved By: .,,e -" /i <br /> ' Date: " / � jDsite Work/Drainage(shown/triggered) <br /> /// IOAddress Letter <br /> FIRE DEPARTMENT ;DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: �(denfal,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: 1 . <br /> Additional Notes: D This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: D A Separate PW Permit is Required(Permit#:PW ) <br /> D 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 /> D Review/inspection Scope-ADD FIRE FEE D Is in a Separate Green Folder gain with this folder for permit issuance) <br /> Approved By: Date: _ D 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 . dditional Notes: <br /> • <br /> Additional Notes: ` <br /> Approved By: Date: Completed By:"� Date: y.47.12,Ai <br />