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glsttA C A sSStJ A-e .I ;_,Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# `� 00R -n <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone /it_ K <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Irisp) Overlay/Agreement --- <br /> Bldg/TI/Addn/Rem Size Nonresidential Use r <br /> Garage/Accessory Struct. Size Residential Use - <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Ye: , Fin/Unfin Total No.of Dwelling Units: -- <br /> Type of Construction �f Planning/Landscape Inspection Required before Final? ayes ❑No <br /> Occupancy Group �(/ "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load d School Impact Fee: Total $ <br /> Cert. of Occpuancy Required o DYes ❑Shell Only Calculated: Credit: <br /> Code Year // 2021 02018 02015 ❑Eve rett School Dist DMukilteo School Dist <br /> Fire Sprinklers: Update Existi New System Not Req'd Park Impact Fees for permits applie9 for after 1/1/2022: <br /> Reason Sprinklers Re u'if)d: Park Impact Fee Total /d 7 rnet due after credit for existing uses) <br /> Fire Alarm: ❑U �JE fisting ❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year): —26/2 2 <br /> q q' permit? DYes ❑ No `.. l %. -..2_.,__.......3 ( ... ........., y,... ,,. .....,,.,.,...,,,,.....,..,.....,..,,,.,.,,,,...,....,,,,.,,,. <br /> Reason Fire Alarm R ui d: � .J9 <br /> RCW 64.55 MF worksheet d for <br /> Add'I RCW 64.55 docs r uired prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: -'------Date: ) Z - (Y - 7 j <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: DWater OSewer ❑Storm <br /> I <br /> IOTraffic Mitigation Eval <br /> Approved By: 4_�� Date: Ore_ 27 j,3 IDSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT DBackflow Prevention for high hazard: <br /> (dSeparate/Deferred Submittals Required: .hospintal,tal, <br /> medical,r veanihousi mortuary, <br /> p q hospital,supportive housing) <br /> OFire 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 0 Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> id Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder tofu with this folder for permit issuance) <br /> Approved By: cti1,1 Date: 1_,?_3''•:-.2__? 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 Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By>y � Date: /Z/O&/zot <br />