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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# - (;),3o� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: (x Date: t2 DGf' 207$ <br /> Intake Comments: Intake Comments: <br /> Zone L12.ElMake this a"W"Permit ElSRC Required (Pre-Insp) Overlay/Agreement A:i po1} n�oM p +. Aroo► <br /> Bldg/Tl/Addn/Rem Size NiA Nonresidential Use <br /> Garage/Accessory Struct. Size 1(1;- Residential Use <br /> Number of Stories (VA 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? ❑Yes No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ 0 <br /> Occupancy Load School Impact Fee: Total $ _ 0 _ <br /> Cert. of Occpuancy Required? toNo Dyes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 1212018 02015 DEverett School Dist DMukilteo School Dist <br /> Fire Sprinklers: El Update Existing El New System Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System pNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I 1 No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ► INo Additional Notes: <br /> VALUATION CALCULATION: Total $ L(iJ u" <br /> Approved By: , Date: 12. D Gt �J <br /> _1 PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: ,PW Review&Worksheet Needed if: <br /> j❑Sys Dev Eval: <br /> Additional Notes: • ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: A �, Date:al irl1nt3 IOSite Work/Drainage(shown/triggered) <br /> I❑Address Letter <br /> FIRE DEPARTMENT iElBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: ;(dental,medical,animals,mortuary, <br /> p q :hospital,supportive housing) <br /> .�rire Sp�rinRters_. ❑Fire Alarm ❑Other: <br /> Additiona'I 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:(‘C Tlli,c)•(N Date: '` -)1.1 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: Ifigizet3 <br />