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Intake & Approval Sheet (FOR PERMIT STAFF O kAC ERMIT# <br /> j230g <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 Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories 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? —]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 ❑2021 112018. ❑2015 ❑Everett School Dist ❑Mukilteo 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: El Update 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 ❑ No <br /> Add'I RCW 64.55 docs required prior to final? []Yes []No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> I 60��' / -1-J q,7 f. L{S Approved By: U Date: 24 -24 <br /> 66 <br /> UBLIC WORKS <br /> v2/ ,`.1"�l q + a;?t'70a Intake OK by: Date: <br /> 'o Intake Comments: IPWRevie►v&Worksheet Needed if <br /> OSys Dev Eval <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> i <br /> i <br /> OTraffic Mitigation Eva] <br /> Approved By: Date: ![]Site Work/Drainage(shown/triggered) <br /> OAddress Letter <br /> FIRE DEPARTMENT 1113ackfiow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: hospital,supportive housing) <br /> El 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: ❑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(Join with this folderfor permit issuance) <br /> Approved By: Date: ❑ 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 /> ELECTRICAUPLUMB11 G Additional Notes: <br /> Additional Notes: "0' C,4a (.. _ o: s <br /> Approved By: Date; Completed By: E' G Date, z,4 <br />