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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 67/V ()S." D2- <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To:J es Date: 512`'1/2y <br /> Intake Comments: Intake Comme <br /> Zone <br /> ❑ Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement A IA +- A CA <br /> Bldg/TI/Addn/Rem Size (1.) . LG 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 Planning/Landscape Inspection Required before Final? ❑Yes l3No <br /> Occupancy Group c-k �, "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. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System L `s Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$() (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ElNo <br /> W Add'I RC 64.55 docs required prior to final? ❑Yes t lNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 50,00 <br /> Approved By: Date:sslzy 12.4-{ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PWReview&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: I DWater DSewer ❑Storm <br /> OTraffic Mitigation Eval <br /> Approved By: � Date: la 1 s0k:L A OSite Work/Drainage(shown/triggered) <br /> �DAddress Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: . dental,medical,animals,mortuary, <br /> p qhospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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 /> RI/Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder[join with this folder for permit issuance) <br /> Approved By:K � Date:S�y� ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ublic Works has no scope on this permit---PW Not Required <br /> • .. ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By!"-.Tyy ,SAt Date: 9 // / 1y <br />