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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) S PERMIT# 30,7 " O601. <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> 0 Make this a"W"Permit 0 SRC Required (Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size - t Nonresidential Use <br /> Garage/Accessory Struct.Size 40••• Residential Use <br /> Number of Stories 1 Proposed No.of Dwelling Units: <br /> Basement '`.No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction 6 Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load tl4 School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? IFI,No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 KI2018 02015 El Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: FlUpdate Existing ❑New System INNot 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 ❑New System fig Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: In RCW 64.55 MF worksheet req'd for permit? ❑Yes In No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes a,1No Additiona tes: <br /> VALUATION CALCULATION: Total$ ,A! QOQ `^ I 1 ii j /2-i /2-2 <br /> roved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: (10113 I❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental, , , , <br /> p q .hospital,medical supportiveanimals housing)mortuary <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: 3 <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 /> B Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:\ Q- w Date: 10-1Oi3 ❑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 />