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intake & Approval Sheet ' (FOR PERMIT STAFF ONLY) PERMIT # >(7 ®C;�-- <br />(q <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories I'� <br />LCQ1C <br />Basement <br />❑No CIYes , Fin 1 Unfin <br />Type of Construction <br />Occupancy Group <br />-- j <br />Occupancy Load <br />41A Hd v- <br />Celt. of Occpuancy Required? <br />YNo E]Yes []Shell Only <br />Code Year <br />[]2021 M018 ❑2015 <br />Fire Sprinklers: WUpdate Existing ❑New System []Not Req'd <br />Reason Sprinklers Required: ZT-2VrLff1k6— ,f 11 <br />Fire Alarm: ❑Update Existing ❑New System E]Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes '0 No <br />Addl RCW. 64.55 docs required prior to final? []Yes ONO <br />VALUATION CALCULATION: Total $ 60a DG® <br />Additional Notes: — l,J' 45�44� <br />Approved By. Date: 02 �77 f'? <br />FIRE DEPARTMENT <br />Separate 1 Deferred Submittals Required: <br />[]Fire Sprinklers ❑Fire Alarm []Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />Review of As -Built Plans - NO FiRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />El Review/ inspection Scope -ADD FIRE FEE <br />Approved By: Date: sL !7 IZ�1 <br />E1-EOT.RICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist []Mukilteo School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park impact Fee Total $ (net due after credit for ex/sting uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: Z' <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: pWITIVietisr&WorksheetNeededif:N - <br />[]Sys Dev Eval : <br />[]Water ❑Sewer ❑Storm <br />ElTraffic Mitigation Eval <br />[(Site Work/Drainage (shown/triggered) <br />hAddress Letter <br />i <br />�E18ackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />s <br />This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ ASeparate PW Permit is Required (Permit#: PW ) <br />AND ❑ is fully digital <br />r[]I Is located In this folder <br />!_1 Is in a Separate Green Folder QoinwiththlsfolderforpermltIssuance) <br />Q 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 />Additional Notes: <br />b • <br />Completed Date:L <br />IV� <br />