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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# o . ® [ -030 <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-fnsp) Overlay/Agreement <br /> Bldg/Tl/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories C Proposed No.of Dwelling Units: <br /> Basement t17 No DYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction (,(, Planning/Landscape Inspection Required before Final? DYes ONo <br /> Occupancy Group („ "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 44-(' School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? RINo DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 ®2018 02015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing Mew System IgiNot 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 El New System ®Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes [4 No <br /> Add'I RCW 64.55 docs required prior to final? DYes 1No Additional Notes: <br /> VALUATION CALCULATION: Total$ t,Q 9 <br /> Approved By: Date: <br /> i <br /> ` d K. PUBLIC WORKS <br /> Intake OK by: Date: <br /> 019 Intake Comments: IPW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: OWater OSewer ❑Storm <br /> DTraffic Mitigation Eva! <br /> Approved By: C \).-itl�.,....,�Date: t 2, 151->- 3❑Site Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> p q hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: bit This Permit is Approved by Public Works <br /> .See PW Review Worksheet and associated attached ite <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 Gain with this fol error permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Po er,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope on this permit---P Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:), /J j Date: J LIOs/t,L3 <br />