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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY • PERMIT# �sdN IO oq 0 <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 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size 0 aK/ Nonresidential Use <br /> Garage/Accessory Struct.Size 0 ft/e") Residential Use <br /> Number of Stories 3 Proposed No.of Dwelling Units: <br /> Basement ' INo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction V4 Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group 1Z--Y "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load (22- School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? giNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 ' I2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System Ti5Not 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: ❑Update Existing El New System 8Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I No <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes I No Additional Notes: <br /> VALUATION CALCULATION: Total$ J 7- 3(o4.73 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: IPW Review&Worksheet Needed if: <br /> DSys Dev Eval: <br /> ❑Water ❑Sewer ❑Storm <br /> Additional Notes: Atria � k Y1NJIiNtS I <br /> f11` b i[Traffic Mitigation Eval <br /> Approved By: vi .,_,, Date: [V b / DSite Work/Drainage(shown/triggered) <br /> it i['Address Letter <br /> I <br /> FIRE DEPARTMENT (DBackflow Prevention for high hazard: <br /> (dental,Separate!Deferred Submittals Required: ,hospita medical,r animals,mortuary, <br /> !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-NO FIRE 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 0 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: Completed By: Date: <br />