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' \AS) OrS Ofitr \S tM ��- <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2l/V - 03 a <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:_51 v/vh11 Date: 7/61/00Zt <br /> Intake Comments: Intake Comments: <br /> Zone /l/I L) <br /> ❑ Make this a"W"Permit 0 SRC Required (Pre-lnsp) Overlay/Agreement <br /> BldglTl/Addn/Rem Size Nonresidential Use ((/QLa✓tf) <br /> _Garage/Accessory Struct. Size , Residential Use <br /> Number of Stories 1 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 pNo <br /> Occupancy Group 1/4 "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load �"� School Impact Fee: Total $ r2 v <br /> Cert.of Occpuancy Required? lallo DYes ❑Shell Only _ Calculated: Credit: <br /> Code Year 02021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System PNot Req'd Park Impact Fees for permits a plied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total 0 (net due after credit for existing uses) <br /> Fire Alarm: ❑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 0 No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes QNo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: `D if <br /> 6 <br /> f2_O21 <br /> " w0\.,r <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: fPW Review&Worksheet Needed if: <br /> IDSys Dev Eval: <br /> ❑Water ❑Sewer ❑Storm <br /> Additional Notes: <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: - 11,1 I OSite Work/Drainage(shown/triggered) <br /> 1❑Address Letter <br /> FIRE DEPARTMENT ICIBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> :hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm El Other: <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> 0 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 /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join 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 B /f Date: 7/fz1te7 <br />