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I 11 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLI) PERMIT# V r b <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/T]/AddrCRem ze /7Plu�jnfitrn, <br /> ' Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories _ Proposed No.of Dwelling Units: <br /> Basement No ❑Ye 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$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? Wo ❑Yes ❑Shell Only Calculated: Cred't: <br /> Code Year �2021 ❑2018. ❑2015 El Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: wpdate Existing ❑New System ❑Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: pdate Existing ❑New System []Not Req'd Fee Schedule Used For Calculation(Year): <br /> . .,,.........................._..,.............._.....__.._.-....... ........., .�...... <br /> Reason Fire Alarm Required: _. <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add1 RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ V Lr• Covk p,J <br /> Approved By-AeA for J Date: '� Z <br /> PUBLIC WORKS <br /> Intake OK by:( Date Intake Comments: PW Review&Worksheet Needed if.• <br /> USyE Dev Eval: <br /> Additional Notes: F Elwater ❑Sewer ❑Storm <br /> I❑Tra fic Mitigation Eval <br /> Approved By: Date: EI]Sit Work/Drainage(shown/triggered) <br /> 11Adc ress Letter <br /> FIRE DEPARTMENT - 11Bac dow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: �(denta,medical,animals,mortuary, <br /> !hospital,supportive housing) <br /> 14FtFe Sprinklers Nfire Alarm ❑Other: 1 <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associ ted attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Pe it#:PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> P Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> r_! Keview/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Golp with this folderfor permit issuance) <br /> Approved By: Date: ❑ Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> V2 Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: Q r C4y,n D P� <br /> Approved By: Date: lCompleted By: Date: <br /> S MA cye <br />