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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) PERMIT# 12 O v^ U 4-2- <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 /7p C c Nonresidential Use <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 /> i <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group 13 "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load /# School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No 0Yes ❑Shell Only Calculated: Credit: <br /> Code Year ❑2021 JE(2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:InUpdate Existing ❑New System El Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: l' 45 Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: Update Existing ❑New System El Not Reqd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: Z( fL f/0~7 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes , -No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes t1No Additional Notes: <br /> VALUATION CALCULATION: Total$ 4-,OUJ <br /> Approved By: e--/ r Date: L t Lie-- 4527 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> :❑Sys Dev Eval: <br /> t Additional Notes: OWater DSewer ❑Storm <br /> I <br /> {I❑Traffic Mitigation Eval <br /> Approved By: ,�fj�j� Date: zg t..r )' 1❑Site Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Se arate/Deferred Submittals Required: (dental,medical,ve animals,oui mortuary, <br /> rr,,��ii !hospital,supportive housing) <br /> al Fire Sprinklers +�IFireAlarm ❑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_t ) Date: �- 2 I =J ❑ 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: L Date: lr®�i(�r— <br />