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V I Si 011 4-441. 1S <br /> mirlit <br /> Intake &Approval Sheet ElliQ(FOR PERMIT STAFF ONLY) PERMIT# PQ 'D5.07 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-lnsp) 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 ONo DYes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction 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 DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 02015 ❑Everett School Dist DMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not 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: ❑Update Existing ONew System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ❑ No <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total rf <br /> �l J Approved By: .(,/4. Date: cif/2,6/2._e2,3 <br /> V t A" PUBLIC WORKS <br /> (' Intake OK by: Date <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> OSys Dev Eval: <br /> Additional Notes: ❑Water DSewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved 1ct7 Dater ra/Zdc..,J ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Separate <br /> 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 /> El Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: (mow Date: '- ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 'if-Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed Br,,,,��?` Date; p$ fQs1-7-oe3 <br />