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2 � 22 <br /> • • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#-62300 0 J I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: 0 <br /> Zone L-12 <br /> o Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use ��`(�j��f '('' r(Q <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? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ -' <br /> Cert.of Occpuancy Required? El No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1:12021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System liNot 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 INot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1 No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes . No A ditional Not <br /> VALUATION CALCULATION: Total$9/ 0416:40 �� � (}�C' "' <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date dt I' 112-617j <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional otes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved Date fret 7 DSite Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT I OBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,houi mortuary, <br /> p q hospital,supportive housing) <br /> El 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 ❑ Is located in this folder <br /> 'Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:'t 1 )0,5(2)n Date: /' 6'-q ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 121 Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: �� )2bL3 <br /> Approved By: Date: Completed By: Date: <br />