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• S �f p.,Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# v3oU <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: lie" Assign To:.�e.SS Date: II 1/23 <br /> Intake Comments: Intake Comments: <br /> Zone Pj <br /> ❑ Make this a"W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement N/A <br /> Bldg/TI/Addn/Rem Size NA- Nonresidential Use reta.t sates &se.rvice.5 <br /> Garage/Accessory Struct. Size PIA Residential Use N/A <br /> Number of Stories 1. Proposed No. of Dwelling Units: M/P4 <br /> Basement No ❑Yes , Fin/Unfin Total No.of Dwelling Units: NSA <br /> Type of Construction V Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load +V School Impact Fee: Total $ ('7 <br /> Cert. of Occpuancy Required? ITINo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 @2018 ❑2015 CI Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System LNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: rra�tt Park Impact Fee Total$ `% (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System E 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 E0 No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes Q.No Additional Notes: <br /> VALUATION CALCULATION: Total $ 1 QD c. <br /> Approved By: Date:9/7/Z3 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: DWater DSewer OStorm <br /> �; ��J I`01� 0t t !�e!Vtn,,�Vr ❑Trac Mitigation Eval <br /> s ffiJ i <br /> Approved By: :, (S� Date: 91 �—�7 1 1 I DSite Work/Drainage(shown/triggered) <br /> ( J 1 DAddress Letter <br /> FIRE DEPARTMENT IDBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: !(dental,medical,pr animals,houi mortuary, <br /> p q ;hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: in,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 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: Completed By:/44? 7 e5 <br /> �� Date: n8 f 7+�•20L1 <br />