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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # ' 0�i7 <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 <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />kit S li <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />R-No ❑Yes []Shell Only <br />Code Year I ®2021 112018. 112015 <br />Fire Sprinklers: ❑Update Existing ❑New System IDNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System IPNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'] RCW 64.55 docs required prior to final? ❑Yes 1PNO <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: pate: <br />FIRE DEPARTMENT <br />Separate / 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 />Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: J e, SS Date: 2H `2. <br />Intake Commedg. <br />Zone <br />t{_ <br />Overlay/Agreement <br />A i At + AC A <br />Nonresidential Use <br />Residential Use <br />— <br />Proposed No. of Dwelling Units: <br />�— <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes Mo <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 1/1/2022: <br />Park Impact Fee Total $ (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: L4 <br />U v <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Review & Worksheet Needed if <br />[E]Sys Dev Eva[ : <br />❑Water ❑Sewer ❑Storm <br />I <br />I ❑Traffic Mitigation Eval <br />10Site Work/Drainage (shown/triggered) <br />Address Letter <br />1 <br />I ❑Backflow Prevention for high hazard: <br />I(dentai, medical, animals, mortuary, <br />hospital, supportive housing) <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ Will be issued separately (separate Green Folder, PW issued ahead of Bidg) <br />VPublic Works has no scope on this permit --- PW Not Required <br />4dditlonal Notes: <br />Completed By: Date: ZOZ <br />v j <br />