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Intake &Approval Sheet OR PERMIT STAFF ONLY) •IT# 1O( D 7�'- <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 /> Bldg/T1/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement DNo es, 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? 21No DYes '}Shell Only Calculated: Credit: <br /> Code Year E12021 ?_12018 E12015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers:DUpdate Existing DNew System INot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> - Reason Reason Sprinklers Required: Park impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing DNew Systemot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ,}' No <br /> Add'lRCW.64.55 does required prior tofinal? D TJ Yes No Additional Notes: R' /n� ��� <br /> VALUATION CALCULATION: Total$, 40),5 c , <br /> Approved By: jam. Date: 5 £ ,. <br /> 2,1 <br /> PUB.LICWORKS . . ' <br /> Intake OK by: Date: _ <br /> . <br /> • Intake Comments: f PWReview&Worksheet Needed if:: �.w <br /> • ,DSys Dev Eva!: <br /> Additional Notes: O hl -� ? ate �7Water ❑Sewer ❑Storm <br /> I QTraffiic Mitigation Eval <br /> Approved By: / Date: cc-et?)�, jDSite Work/Drainage(shownitriggered) <br /> . IDAddress Letter <br /> FIR ME E DEPARTMENT . ;DBackfiow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: hospital,supportive housing) <br /> DFire Sprinklers ❑Fire Alarm DOther: 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: 0 A Separate PW Permit is Required(Permit#:PW ) <br /> D Review of As-Built Plans-NO FiRE FEE AND 0 Is fully digital <br /> D Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> D Review/Inspection Scope-ADD FIRE FEE D Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: Date: . D 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 . Additiona►Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: �Ce,,,..7t./ <br />