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Intake &Approval Sheet • (FOR PERMIT STAFF ONL • PERMIT# elZ3O9 oi' I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone -2. <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size �i c�� /` Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use y�5 <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 511No <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 fif2018 1=12015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System MNot 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 ❑New System C-JNot Req'd Fee Schedule Used For Calcu ation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Ef No <br /> Add'RCW 64.55 docs required prior to final? ❑Yes 4No Additional Notes: <br /> VALUATION CALCULATION: Total$ ?4)ec0 <br /> Approved By: 7�0,4U C1 Date: /0/jD2� <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> OTraffic Mitigation Eval <br /> Approved By: Date:pitigc,p2 Mite Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT IDBackflow 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 coin with this folder for permit issuance) <br /> Approved By: Date• ❑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: J 4c 0.1/1/ Oki/ <br /> Approved By: Date: Completed By:4. 3preV14 Date: 4�ff1!zolg <br />