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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# p s3((' 0 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/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑ -s, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Req "red before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? di No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Upda Existing El New System ❑Not Req'd Park Impact Fees for ,-rmits applied for after 1/1/2022: <br /> Reason Sprinklers '-quired: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: Prd Update Existing ❑New System ❑Not Req'd Fee Schedule Used '`or Calculation(Year): <br /> Reason Fir- •larm Required: <br /> RCW 64: MF worksheet req'd for permit? ❑Yes ❑ No <br /> Ads' 'CW 64.55 docs required prior to final? ❑Yes ❑No Addition. Notes: <br /> VALUATION CALCULATION: Total$ /J 161 <br /> Ap• oved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> 10Sys Dev Eval: <br /> Additional Notes: Ass OWater OSewer ❑Storm <br /> �K ) I Traffic Mitigation Eval <br /> J Approved By: + r Date: ,2 5�i DSite Work/Drainage(shown/triggered)J �Address Letter <br /> FIRE DEPARTMENT DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: !(dental,medical,animals,mortuary, <br /> p q :hospital,supportive housing) <br /> 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: 0 A Separate PW Permit is Required(Permit#:PW <br /> ❑Review of As-Built Plans-NO FIRE FEE AND 0 Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> Z Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Ca-7k,h Date: j _ ,i3 ❑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 />