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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# ?,(40z/ l <br /> BUILDING �/� PLANNING <br /> Intake OK by: Date: Intake OK by: a' f� Assign To: c.esb Date:rjf 2(Z�{ <br /> Intake Comments: Intake Comments. <br /> Zone 1-i <br /> ❑Make this a"W"Permit ❑ SRC Required (Pre-lnsp) Overlay/Agreement A IA + A C A <br /> Bldg/TI/Addn/Rem Size Nonresidential Use 14:431i 1 n <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? Oyes,EINo <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ a <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ' No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year V2021 02018. 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System Slot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ b (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System WNot 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 111No Additional Notes: <br /> VALUATION CALCULATION: Total$ %Vo010 <br /> Approved By Date:5/2//.9 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: tPW Review&Worksheet Needed if: <br /> IDSys Dev Eva!: <br /> I <br /> ❑Water DSewer OStorm <br /> Additional Notes: <br /> DTraffic Mitigation Eval <br /> Approved By: C IO Date: Si l `ll IDSite Work/Drainage(shown/triggered) <br /> \ ;DAddress Letter <br /> FIRE DEPARTMENT I DBackflow Prevention for high hazard: <br /> /Deferred Submittals Required: [(dental,medical,animals,mortuary, <br /> Separate <br /> ;hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: This Permit is Approved by Public Work <br /> J '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: �y I Date: y 36-�y ❑ 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: p 41.44/ 24- <br />