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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 6MD-1 — 22-3 <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 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> ,Bldg/Tl/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 OShell Only Calculated: Credit: <br /> Code Year 02021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El 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: ❑Update Existing El New System ❑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 /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: [PWReview&Worksheet Needed if: <br /> ['Sys Dev Eval: <br /> Additional Notes: <br /> ❑Water ❑Sewer ❑Storm <br /> =['Traffic Mitigation Eval <br /> Approved By: Date: I['Site Work/Drainage(shown/triggered) <br /> ['Address Letter <br /> FIRE DEPARTMENT IDBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> :hospital,supportive housing) <br /> ❑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 /> 0 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder fain with this folder for 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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: �� `— Date: / 31 7 Completed By: Date: <br />