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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 1'l <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 yes <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? ❑Yes fallo <br /> "In Lieu" Fee:Type: Amount$ <br /> Occupancy Group <br /> j R-LyP <br /> Occupancy Load -G_(—(_ School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? QNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 W2018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ y3 (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System ®Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I1 No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes INo Additional Notes: <br /> VALUATION CALCULATION: Total $ a a.0 <br /> Approved By: 1-r ii/rj 4l/ut Date: 5/6,12023 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: I PW Review 8,Worksheet Needed if: <br /> 1❑Sys Dev Eval: <br /> Additional Notes: OWater ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: C„,fs,„.._,„-.Y__ Date: j i ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> /Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Separate <br /> Ihospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: <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 0 Is located in this folder <br /> O Review/Inspection Scope ADD FIRE FEE ❑ Is in a Separate Green Folder toin with this folder for permit issuance) <br /> Approved By: Date: ❑ 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 />