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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �J & D—I <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? 9Yes []No <br /> Occupancy Group "In Lieu"Fee:Type: — Am $ <br /> Occupancy Load School Impact Fee: Total $ G 6 lLIL 07 <br /> Cert.of Occpuancy Required? ❑No WYes []Shell Only Calculated: Credit. .� <br /> Code Year ❑2021 �2018 ❑2015 ❑Everett School Dist Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing []New System QNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ X,1_4f_6 (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing El New System QNot Req'd Fee Schedule Used For Calculation(Year): ,?OA 3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Q No <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ 21CI 4-b <br /> Approved By: ate: O— G 'z <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: ;PIN Review&Worksheef Needed if. -- <br /> I❑Sys Dev Eval <br /> Additional Notes: <br /> ❑Water ❑Sewer []Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: ! )Igl ;i7 []Site Work/Drainage(shown/triggered) <br /> []Address Letter <br /> FIRE DEPARTMENT ;❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: hospital,supportive housing) <br /> []Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: Q)-his 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 /> 19 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Qoln with this folderfor permit issuance) <br /> Approved By: 3717 Date:jo-?,7�' ❑ 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 /> ELECTRICAUPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: �— ate: !a io 7eZ3 <br />