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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# Sd310 6 9? <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 /> BldglTl/Addn/Rem Size t AAA.) Nonresidential Use <br /> Garage/Accessory Struct.Size D Residential Use <br /> Number of Stories 3 Proposed No.of Dwelling Units: <br /> Basement Egl.No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction V3 Planning/Landscape inspection Required before Final? DYes ❑No <br /> Occupancy Group E.2. "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load (}f�' School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? Mlo DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 NE2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ONew System giNot 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 IRINot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes PSI 7INo <br /> Add'I RCW 64.55 docs required prior to final? DYes 1,No Additional Notes: <br /> VALUATION CALCULATION: Total$ 32, to/,S$ <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 /> Additional Notes: Apov el/ f5 ❑Water OSewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: k Date: ((16 /�) l DSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT 'DBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers El 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 ❑ Is in a Separate Green Folder Coin 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 />