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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT#.6 1 V O(O 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:_ Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> , <br /> Zone <br /> • <br /> ❑ Make this a "W" Permit 0 SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size i .t! Nonresidential Use <br /> • <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No. of Dwelling Units: <br /> Basement EZINo ❑Yes , Fin /Unfin Total No. of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group Y) S! "In Lieu" Fee: Type: Amount$ <br /> Occupancy Load 4.%44 School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? ®No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 2021 02018 1:12015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing New System ElNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total 5 (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing New System MNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? El Yes ` ' No <br /> Add'I RCW 64.55 docs required prior to final? DYes No Additional Notes: <br /> VALUATION CALCULATION: Total $ 7)1, <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: j PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> i <br /> 1❑Traffic Mitigation Eval <br /> Approved By: t, Date: _47*,� :� ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ;❑Backflow Prevention for high hazard: <br /> !(dental,medical, <br /> Separate/Deferred Submittals Required: animals, mortuary, <br /> !hospital,supportive housing)s <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: 0 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 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: y � Date: .-30 4.' ❑ 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 Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />