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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#?)23cO —o._JI.J <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 'IVA <br /> Bldg/TI/Addn/Rem Size Yk I Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement 2 No ❑Yes , Fin/Unfin Total No.of Dwelling Units: / <br /> Type of Construction Q Planning/Landscape Inspection Required before Final? Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: — Amount$ <br /> Occupancy Load TEE School Impact Fee: Total $ / — <br /> Cert.of Occpuancy Required? ❑No ®Yes ❑Shell Only Calculated: //Z1 Credit: --- <br /> Code Year ❑2021 132018 ❑2015 ❑Everett School Dist [3­Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System QNot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ U (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System QNot Req'd Fee Schedule Used For Calculation(Year): d(21 3 <br /> —— --Reason Fire Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes [11 No <br /> Add'I RCW 64.55 docs required priorto final? ❑Yes ©No Additional Notes: <br /> VALUATION CALCULATION: Total$ % y V. <br /> Approved By: /1G Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: _ <br /> Intake Comments: — �—— <br /> PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eva] <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: ID Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> I <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> !(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> !hospital,supportive housing) <br /> ❑Fire Sprinklers El Fire Alarm ❑Other: i <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: :i ❑ WIII 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: 119 1j4D <br />