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Intake &Approval Sheet 110OR PERMIT STAFF ONLY) •RM1T# g v-30- — <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone Oa U <br /> 0 Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bidg/TI/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 V Q Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group B ' "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? IgNo ❑Yes ❑Shelf Only Calculated: Credit: <br /> Code Year 02021 [42018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing[New System in 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❑New System V3Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ZI No <br /> Addl RCW.64.55 docs required prior to final? ❑Yes EiNo Additio a Notes: //',/J�1 <br /> VALUATION CALCULATION: Total$ (fjt 161 //®/ I/U 1 VD/ <br /> pproved y: +� �` ` ate: <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: JPW Review&Worksheet Needed If: <br /> • 1❑Sys Dev Eval: <br /> Additional Notes: OWater ❑Sewer ❑Storm <br /> tuTraffic Mitigation Eva[ <br /> Approved By: L j _prstn\ Date: a ' FDSite Work/Drainage(shown/triggered) <br /> V►1+� „� � Z� [DAddress Letter <br /> d <br /> FIRE DEPARTM.NT `DBackflow Prevention for high hazard: <br /> • <br /> (dSeparate/Deferred Submittals Required: ho pt l supportivemupat animals,mortuary, <br /> p q thospital, housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: t <br /> Additional Notes: 0 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(join with this folderfor permit issuance) <br /> Approved By:y,5427w I Date: /—/DG/ ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> aZublic Works has no scope on this permit---PW Not Required <br /> • ELEGTRICAL/PLUMBING Additional Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed S��GL__,Y Date: /Z 13of 1 s t,3 <br />