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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY • PERMIT# I r I U� 0V 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 rne(ti (ci O ri i <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No. of Dwelling Units: <br /> Basement DNo DYes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? El No DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 02015 ❑Everett School Dist DMukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ❑New System DNot 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: DUpdate Existing El 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? DYes ❑ No <br /> Add'I RCW 64.55 docs required prior to final?$ DYes ❑No Addition I Notes' /,���/�� <br /> VALUATION CALCULATION: Total �.r OG��irJ� r16 `Q/ <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: I PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> 1 <br /> Additional Notes: 1 OWater ❑Sewer ❑Storm <br /> ❑ <br /> ITraffic Mitigation Eval <br /> Approved Date: fJ 0 7 '/J � !Mite Work/Drainage(shown/triggered)/ / �❑Address Letter <br /> FIRE DEPARTMENT 10Backflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Separate <br /> !hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm DOther: 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 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: Date: <br />