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Intake &Approval Sheet i (FOR PERMIT STAFF ONLY) • PERMIT# 3(0 - Q `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 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size 0 l►Pam. Nonresidential Use <br /> Garage/Accessory Struct.Size n eio Residential Use <br /> Number of Stories 7j Proposed No.of Dwelling Units: <br /> Basement mNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction V 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? 133No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 0202112018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System INot 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 InNot 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'l RCW 64.55 does required prior to final? ❑Yes JUNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 4( ,366. G.c <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Evai: <br /> Additional Notes: Cppil r me, s OWater ❑Sewer ❑Storm <br /> //` ❑Traffic Mitigation Eval <br /> Approved By: (,� //..,� Date: I(/b /;) DSite Work/Drainage(shown/triggered) <br /> Y ! DAddress Letter <br /> i <br /> FIRE DEPARTMENT 1DBackflow Prevention for high hazard: <br /> (dental,medical, <br /> Separate/Deferred Submittals Required: animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <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 0 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: 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 />