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Intake &Approval Sheet <br /> (FOR PERMIT STAFF ONLY) • PERMIT# 62-4 t 01 <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/T1/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement kw—No ❑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? 'No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1E12021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System IPNot 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: . .Jpdate Existing 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 173 No <br /> Add'l RCW 64.55 dots required prior to final? ❑Yes INo Additional Notes: <br /> VALUATION CALCULATION: Total$ tp1 UA.& <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if W <br /> ❑Sys Dev Eval: <br /> Additional Notes: I ❑Water OSewer ❑Storm <br /> OTraffic Mitigation Eval <br /> Approved By: 9ArM c.._ Date: N!Z4-1�,y ❑Site Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEPARTMENT 10Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary, <br /> Separate I Deferred Submittals Required: ! <br /> hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: 41 <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 /> la-Review Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: K.647.2 f,,,n Date: 6_ / ❑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 />