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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2,4ktY¼S <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 AN)1 ?I STc , r-ita Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories �-,� Proposed No. of Dwelling Units: <br /> Basement DINo ❑Yes , Fin/Unfin Total No. of Dwelling Units: <br /> Type of Construction ///-' Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group f'-( , 5 i "In Lieu" Fee: Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? ,�No DYes OShell Only Calculated: Credit: <br /> Code Year � L`'f2021 02018 Elam ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: I Update Existing ONew System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers quired: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: QUpdate 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'l RCW 64.55 docs required prior to final? DYes LJNo Additional Notes: <br /> VALUATION CALCULATION: Total $ /,g'L�r •_ <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 /> Additional Notes: . ' f91, (2— c $ PSC DWater ❑Sewer DStorm <br /> I <br /> sCO Pg 2/ ❑Traffic Mitigation Eval <br /> Approved B • , n Date: /ih1/ f ,❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT '❑Backflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental,medical,animals, mortuary, <br /> Separate <br /> !hospital, supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: 0 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 ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope- NO FIRE FEE ❑ Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: ❑ 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: Date: <br />