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40 _ <br /> 410 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (0 -0 0 q� <br /> pP � o� <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 D 14 Nonresidential Use <br /> Garage/Accessory Struct.Size 0 taQ.) Residential Use <br /> Number of Stories .) Proposed No.of Dwelling Units: <br /> Basement F\lo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> .13 <br /> Occupancy Group ?i "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load (;2 School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? 1No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 `t12018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System tiNot 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 ❑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? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ ,71J(fii? , T b <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: i <br /> i PW Review&Worksheet Needed if. <br /> DSys Dev Eval: <br /> Additional Notes/Ff4e4( CAAik 49 ❑Water OSewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: (0,004.— Date: [(/6 /a , ❑Site Work/Drainage(shown/triggered) <br /> t DAddress Letter <br /> FIRE DEPARTMENT f DBackflow Prevention for high hazard: <br /> (dental,medical, <br /> Separate/Deferred Submittals Required: animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: I <br /> Additional Notes: 0 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: 0 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 />