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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# 7/" )l0 —DP) <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 f�l Addn/Rem Size sn 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 ONo <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? -A o ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year A 021 02018. 02015 ['Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System IZINot 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 ❑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? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ rl,O11 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: , Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> 11:3Sys Dev Eval: <br /> Additional Notes: OWater ❑Sewer ❑Storm <br /> OTraffic Mitigation Eval <br /> Approved By: Date: J 3/'�tr� ,OSite Work/Drainage(shown/triggered) <br /> I tDAddress Letter <br /> FIRE DEPARTMENT OBackflow Prevention for high hazard: <br /> (dental,mu <br /> Separate/Deferred Submittals Required: .hospital,supportiveanimals,mortuary, <br /> housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: E <br /> Additional Notes: 0 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: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bidg) <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: Date: <br />