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Intake &Approval Sheet OR PERMIT STAFF ONLY) OVIIT# 1? Oa. _O 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 /> BIdg1Tl/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required?"o DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 C712018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:❑Update Existing❑New System %Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> - Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System alot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 1E1 No , <br /> Add'I RCW.64.55 does required prior to final? DYes Jto Additional Notes: <br /> VALUATION CALCULATION: Total$ 5-11 63 _ , <br /> Approved By: Date: <br /> PUBLIC WORKS • <br /> Intake OK by: Date: <br /> Y Man <br /> • Intake Comments: AW Review&Worksheet Needed if: <br /> • ,❑Sys Dev Eval: <br /> OWater ❑Sewer ❑Storm <br /> Additional Notes: <br /> 1DITraffic Mitigation Eva! <br /> Approved By: (L g to 1',-r'!‘ Date:3 t�I l]5ife Work/Drainage(shown/triggered) <br /> fDAddress Letter <br /> FIRE DEPARTMENT • IDBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate 1 Deferred Submittals Required: <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 0 Is located In this folder <br /> ❑Review/inspection Scope-ADD FIRE FEE a Is in a Separate Green Folder(join with this folderfor permit Issuance) <br /> Approved By: Date: . 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/'PLUMBING Additional Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />