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Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT # ),2g04- dq� <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />201 30 5F <br />Garage/Accessory Struct. Size <br />Number of Stories <br />�- <br />Basement <br />No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />2O <br />Cert. of Occpuancy Required? <br />❑No ❑Yes ❑Shell Only <br />Code Year I <br />2021 112018 112015 <br />Fire Sprinklers: OUpdate Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ITUpdate Existing ❑New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes o <br />Add'I RCW 64.55 docs required prior to final? []Yes 9No <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: Date, Gj <br />FIRE'DEPARTMENT ' <br />Separate / Deferred Submittals Required. <br />OFire Sprinklers Oire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />11 <br />Minimal or No Fire Scope - NO FIRE FEE <br />f <br />L�Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />"ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Sl'cke"dO-t1 <br />cbmml a0z <br />Nonresidential Use <br />Residential Use <br />Pr <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes 14No <br />"In Lieu" Fee: Type: Amount $ �J <br />School Impact Fee: Total $ el <br />Calculated: Credit: jo <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: N J <br />Approved By: Date: 0516 112oZ- <br />u <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PWReview &WoiksheetNeeded if.• <br />❑Sys Dev Eval : <br />❑Water []Sewer []Storm <br />N'q GInnM^, �h ,�►r nVj. i <br />❑Traffic Mitigation Eval <br />AA j 1h re`/1 ❑Site Work/Drainage (shown/triggered) <br />l <br />❑Address Letter <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folderforpermit issuance) <br />❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />ram, <br />!bl Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: <br />Date: 0 ! I <br />202 <br />