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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# <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 f Proposed No.of Dwelling Units: <br /> Basement ''� o ❑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? lifdNo Oyes ❑Shell Only Calculated: Credit: <br /> Code Year "IT.12021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System Not 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: El Update Existing El New System INot Req'd . Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I No <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes 'INo Additional Notes: <br /> VALUATION CALCULATION: Total$ .3n <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: 11W Review&Worksheet Needed if <br /> F OSys Dev Eval: <br /> Additional Notes: ❑Water [(Sewer ['Storm <br /> tT I['Traffic Mitigation Eval <br /> Approved By: Cithri..., Date: c1 I['Site Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT I['Backflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 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 /> 0 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:K.6.,r0LA Dater I ( � ❑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 />