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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT# 3 c 30 7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: V2i/Z.3 <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use '(Ps <br /> Number of Stories Proposed No.of Dwelling Units: ` 1.0 <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: 1 <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes oNo <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ONew System Not 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 ❑New System El Not Req'd Fee Schedule Used For Cal lation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br /> Add!RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: S e-e-- Ma"4—+Ps 'vs <br /> VALUATION CALCULATION: Total$ ;N%We%ar Scope r+o't a toed �O`1 ska e�c.n cdhiMtAAS <br /> Approved By:Icdie` i1 Date: 1 4/23 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eva!: <br /> Additional Notes: s Lt. S S(X` 5 OWater ❑Sewer ❑Storm <br /> vyl <br /> OTraffic Mitigation Eval <br /> Approved By:As A Fof C(3 Date: (/yz/t3 [kite Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,ppor veanihousi mortuary, <br /> P q hospital,supportive housing) <br /> El Fire Sprinklers El Fire Alarm DOther: <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 toin with this folder for permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Rublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING', Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed B �� Date: ?(is Ito Z3 <br />