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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone (�,Z 3 <br /> ❑ Make this a"W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size 09 Nonresidential Use A/4 <br /> Garage/Accessory Struct. Size01(2()5 Residential Use Y <br /> Number of Stories Proposed No. of Dwelling Units: `q <br /> Basement to DYes , Fin/Unfin Total No.of Dwelling Units: / q <br /> Type of Construction , L., Planning/Landscape Inspection Required before Final? laYes El No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load Eft School Impact Fee: Total $ Ij /Z/ <br /> Cert. of Occpuancy Required? ❑No Yes ❑Shell Only Calculated: /i/Z/ Credit: <br /> 1 Code Year 02021 2018 ❑2015 ' ❑ r�Everett School Dist yaMukilteo School Dist <br /> Fire Sprinklers: DUpdate Existing El New System Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 3,/Cirt2 (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System I Not Req'd Fee Schedule Used For Calculation(Year): lJz <br /> Reason Fire Alarm Required: 1-1 <br /> RCW 64.55 MF worksheet req'd for permit? DYes El No <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ 37 I o03 <br /> Approved By: � t__ Date: //— /4/-Z 3 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> .............................................................................................................................................................. <br /> Intake Comments: ;PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: DWater ❑Sewer DStorm <br /> `❑Traffic Mitigation Eval <br /> /// <br /> Approved By: , Date: t i I❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> i(dSeparate/Deferred Submittals Required: !hospital,iital tal, animals,mortuary, <br /> P supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: 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 /> Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: (du) Date: 3 ❑ 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:`7 Date: to it ! 2. j 2z 7.� <br />