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Intake $ Approval Sheet (FOR PERMIT STAFF ONL PERMIT#ZZLkD2' C)S+ <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 ,�27,q 4t Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories {MAI h ,St Proposed No.of Dwelling Units: <br /> Basement `ONo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction A Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 7 School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? 31No ❑Yes []Shell Only Calculated: Credit: <br /> Code Year 02021 018. ❑2015 []Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:-EUpdate Existing ❑New System ❑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: MUpd,te Existing ❑New System El 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 Mo <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IONo Additional Notes: <br /> VALUATION CALCULATION: Total$ DO <br /> Approved By: Date: �26 b <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review d Worksheet Needed If., <br /> ,�� []Sys Dev Eval: <br /> Additional Notes: CON TW MCJ-f i-1k - / ❑Water ❑Sewer []Storm <br /> %S2GT !/4N,7 /,k in% /,f ❑Traffic Mitigation Eval <br /> Approved By: Date:O�� 1j y []Site Work/Drainage(shownitriggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Se <br /> p q 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: t�sp ❑ A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE �� AND ❑ Is fully digital <br /> cope- ❑ 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:24 4,�LY ❑Will be issued separately(separate Green Folder,PW Issued ahead of Bldg) <br /> �blic 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: Z41 Z!:Lf- <br />