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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) I PERMIT# 5?„,310 - 096 <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 Q / 144) Nonresidential Use <br /> Garage/Accessory Struct.Size 0 Oti4a/ Residential Use <br /> Number of Stories j Proposed No.of Dwelling Units: <br /> Basement lg3No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction c/ g Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load f 17y School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? INo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 R2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ONew 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: El Update Existing ❑New System INot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: ,.g�( <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes L No Additional Notes: <br /> VALUATION CALCULATION: Total$ 11, <br /> l, 2,1-..03 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> a / s ❑Sys Dev Eval: <br /> Additional Notes: p'p(}�/ (,a414 ,na/G OWater ❑Sewer OStorm <br /> (fff��• ��'��, j Traffic Mitigation Eval <br /> Approved By: (A-..- Date: 1 V6 1i3 I DSite Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> i <br /> FIRE DEPARTMENT IDBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals mortuary, <br /> hospital,supportive housing) <br /> El Fire Sprinklers DFire Alarm ❑Other: f <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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 />