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Intake & Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# P? I Z '003 <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 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 /> Type of Construction Planning/Landscape Inspection Required before Final? []Yes ❑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 1-12021 02018 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing ❑New 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? ❑Yes ❑ No <br /> Add'I RCW 64.55 docs required prior to final? Oyes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: _ <br /> Intake Comments: PW Review&Worksheet Needed if:- <br /> �[]Sys Dev Eval: <br /> I ❑Water ❑Sewer ❑Storm <br /> Additional Notes: ; <br /> 3[]Traffic Mitigation Eval <br /> Approved By: Date: bSite Work/Drainage(shown/triggered) <br /> 11[]Address Letter <br /> FIRE DEPARTMENT I[]Backflow Prevention for high hazard: <br /> ((dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: ,hospital,supportive housing) <br /> p ❑Fire Alarm ❑Other: I Fire S rinklers <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 folderfor 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 /> Additional Notes: <br /> Additional Notes: <br /> Approved By: ! Date: Completed By: Date: <br /> 1 1 -r <br />