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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# I-) <br /> ) 'O (- 066 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone m U <br /> 0 Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use } ' '1A '011 <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 PlanninglLandscape 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? INo [hies ❑Shell Only Calculated: Credit: <br /> Code Year ❑2021 Eg2018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing❑New System @Not Req'd Park Impact Fees for permits applied for after 11112022:/ <br /> Reason Sprinklers Required: Park Impact Fee Total$ Y (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System 13Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 123 No <br /> Add'I RCW 64.55 docs required prior to final? ElYes pNo one! �oteess: //I�0 /L�� <br /> VALUATION CALCULATION: Total$ Ir t p � ��.ltl�ii.d� aJ,I J z`7 . <br /> Approved By: Date: <br /> , <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ,I DSys Dev Eval: <br /> Additional Notes: q I DWater ❑Sewer ❑Storm <br /> V"W t,/`k`� IDTraffic Mitigation Eval <br /> Approved By: (_,. `k Date: &J//' {\ QSite Work/Drainage(shown/triggered) <br /> l I, <br /> ❑Address Letter <br /> FIRE DEPARTMENT QBackflow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: !hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: . <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑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 /> 4 Minimal or No Fire Scope-NO FIRE FEE ❑ 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:\ND co Gt/.n Date: \ �''3 ,2_L( 0 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 By:A('7 /6 , e. Date: p ilgil 7a 2y <br /> iC <br />