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Intake&,Approval Sheet (FOR HERMIT STAFF ONLY) PERMIT# <br /> BUILDING F ANIN0 <br /> intake OK by: Date: Intake OK by: Assign To: T G, Date:u r;l <br /> Intake Comments: Intake Comments: <br /> Rorie <br /> ❑Make this a"W"Permit ❑SRC Required(Pre-Inap) OverlaylAgreement <br /> B1dgiTl/Addn/Rem Size vw % Nonresidential Use <br /> Garage/Accessory Struct.Size Residential UseQ. <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement nrqo Yes, Fin/Unfin Total No.of)Dwelling Units: l <br /> Type of Construction ZR C PlanninglLandscape Inspection Required before Final? ❑Yes 1ANo <br /> Occupancy Group - ' "In Lieu"Fee:Type: Amount$ w� <br /> Occupancy Load — School Impact Fee: Total $ N'I ft <br /> Celt. of Occupancy Required? o dYes DShell Only Calculated: Credit: <br /> Code Year []2021 192018 []2015 QEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:[]-Update Existing ONew System 11M Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park impact Fee Total L 'tj l Ar (net due after credit for existing uses) <br /> FireAlarm: QUpdateExistingONewSystem otReq'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> ..,.......-,.,,.._..„,.,..w.,m.-M <br /> RCW 64.55 MF worksheet req`d for permit? QYes 12 No <br /> Addl RGW 64.55 dots required prior to final? ElYes ®No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> Approved By: Date: <br /> PURLIC W012K8; <br /> Intake OK by: Date: <br /> intake Comments; AWReviexr&WorksheetNeededif- <br /> f0Sys Dev EvaI: <br /> Additional Notes: <br /> 01 . 0�j 1 ElWater QSewer 0Storm <br /> ElTraffic Mitigation EvaI, <br /> Approved By: Date: 10 C(Site WorklDrainage(shownit I gered) <br /> bAddress Letter <br /> I~1RE'DEOARTWNT ❑Sackfow Prevention for high hazard: <br /> ` <br /> Separate I Referred Submittals Required: (dental,medical,animals,mortuary,hospital,supportive housing) <br /> []Fire Sprinklers ❑Fire Alarm []Other.- <br /> Additional Notes: Q This Permit is Approved by Public Works <br /> El 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 /> Review Inspection Scope-ADD FIRE FEE []Is in a Separate Green Folder doinwrththrsMdert'orpem,Itissuance) <br /> Approved By: Date: Will be issued separately(Separate Green Folder,PW issued ahead of6idg) <br /> Public Works has-no scope on this permit---PW Not Required <br /> EL.ECTR(CAL/PLUMBING Additional Notes: <br /> [Approved <br /> dditional Notes: <br /> By., Date: Completed By. Date: ; 2_ <br />