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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 624OP - Dq) <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone —S <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 PNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: 1 <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Occupancy Group "in Lieu"Fee:Type: / Amount$ i <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No ❑Yes []Shell Only Calculated: / Credit: r <br /> Code Year R2021 ❑2018. 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing []New System Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park impact Fee Total$ / (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El 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 Q No <br /> Addl RCW 64.55 does required prior to final? ❑Yes ©No Additional Notes:Dec d%men51br,s C sx,S i Site 1 w i'tv� <br /> VALUATION CALCULATION: Total$—T��+� ' '* _W 15`{ILA <br /> Approved By: Date: 01 2 0 <br /> PUBLIC WORKS <br /> Intake OK by: Date: _ <br /> Intake Comments: PWRevfew&WorksheetNeededif.- <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: „� Date: x []Site Work/Drainage(shovmitriggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backfiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> 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: ❑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(loln with this folder for 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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: Q(Q112, 2 <br />