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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 1% 2- O O O <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:(41 i Date: (0 13 VA <br /> Intake Comments: Intake Comments: <br /> Zone lv <br /> r <br /> ❑Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/Tl/Addn/Rem Size Nonresidential Use (eAaa soi\ts <br /> Garage/Accessory Struct.Size ; Residential Use <br /> Number of Stories 1 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? DYes 4No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? liENo DYes DShell Only Calculated: Credit: <br /> Code Year 02021 1E12018. 02015 ❑Everett School ist DMukilteo 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: 151Update Existing ❑New System Not Req'd Fee Schedule Used For C culation(Year): <br /> Reason Fire Alarm Required: --. _. ..m.._..... <br /> RCW 64.55 MF worksheet req'd for permit? DYes la No 1 d ��� <br /> Add'I RCW 64.55 dots required prior to final? DYes INo Additional Notes: <br /> VALUATION CALCULATION: Total$ ‘Vit 4 00 <br /> e "� Approved By:--1:4°4d'44,,-• Date: (%f Z4 <br /> Uc O PUBLIC WORKS <br /> Intake OK by: Date: <br /> o 0 <br /> ..._...,__..............,..,.,...,..,osheet Need....,.,_ -...W. <br /> Intake Comments: PW Review&Worksheet Needed if': <br /> ci L ;❑Sys Dev Eval: <br /> Additional Notes: OWater ❑Sewer ❑Storm <br /> 3 <br /> OTraffic Mitigation Eval <br /> Approved By: , Date: g/)..g I/(A , Site Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT IDBackflow Prevention for high hazard: <br /> Se arate 1 Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> Wire Sprinklers .Fire Alarm DOther: <br /> Additional Notes: ❑ 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 /> o Minimal or No Fire Scope-NO FIRE FEE ElIs located in this folder <br /> IGT Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: ��yy-1 Date: 6^/) L7 ❑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:`10(J1go,L, Date: J5/2 g/2,e),Zq <br />