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mill old Cc 422Zq22cIntake PProval Sheet �IORPERMITSTAFFONL PERMIT# <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 <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: . <br /> Basement ❑No CIYes, Fin/Unfin Total No.of Dwelling Units: ' <br /> Type of Construction PlanninglLandscape 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? ❑No [Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing ONew System ®Not Req'd Park Impact Fees for permits applied for after 1/112022: <br /> -- Reason Sprinklers Required: Park impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing❑New System Mot 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 /> Addl RCW.64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total,$ <br /> Approved By: Date: <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> • Intake Comments: 1PWReview&Worksheet Needed if: <br /> • ,❑Sys Dev Eval: <br /> :Water (Sewer OStorm <br /> Additional Notes: ' <br /> I OTraffic Mitigation Eval <br /> Approved By: Date: Mite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTM. IT tDBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: hospital,supportive housing) <br /> Fire Sprinklers ❑Fire Alarm ❑Other: 1 • <br /> Additional Notes: . El 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 /> 0 Review of As-Built Plans-NO FIRE FEE AND ❑ is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE d Is located in this folder <br /> El Review/Inspection Scope-ADD FiRE FEE ❑ Is in a Separate Green Folder coin with this foiderfor permit Issuance) <br /> Approved By: Date: . 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Q Public Works has.no scope on this permit---PW Not Required <br /> ELECTRICAL1P MBING • <br /> Additional Notes: <br /> Additional Notes: ` <br /> Approved By(--.4 Date: /a.2/R62 Completed By: Date: <br />