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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# IJ 2 .1. 0 0S 7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone I l t 0 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size C YID Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use 'Ce(1iyi <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement El No EaYes , FI /Unfin Total No.of Dwelling Units: <br /> Type of Construction V i Planning/Landscape Inspection Required before Final? DYes ❑No <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 13K12018 02015 El Everett School Dist DMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System guNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ V (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing El New System tallot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ©No Additional Notes: I n �Q <br /> VALUATION CALCULATION: Total$ �i �/I� ►/y I�� �� <br /> iL ll Approved By: 1(/�V` Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if. <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water Chewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: LIB I, Date: k J) @W i 13 ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> I <br /> FIRE DEPARTMENT 1❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> ;hospital,supportive housing) <br /> DFire Sprinklers El Fire Alarm DOther: j <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 /> '® Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By*`V)..rown Date: , ,—I�/,23 0 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 dditional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: (nfI I (w2, <br />