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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 <br /> ❑ Make this a"W"Permit . " ❑"SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <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 Planning/Landscape 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? ❑No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1:12021 ❑2018 112015 ❑Everett School Dist ❑Mukiiteo 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$ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> ...,...,. . .,.....,......_.._.,.._. .. .._.,.......__.... ._.__._.......... ......_. .,........._,_................._.._.......... ._..........„......_....._.,_. <br /> Reason Fire Alarm Required: ., <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes []No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: <br /> PUBLIC WORKS, <br /> Intake OK by: Date: <br /> .......................,...... ._.................. <br /> �...,..,._._._.. .,,....,,.,_ <br /> Intake Comments: `PW Review&Worksheet Needed if., <br /> ❑Sys Dev Eva] <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: '❑Site Work/Drainage(shown/triggered) <br /> i❑Address Letter <br /> FIRE DEPARTMENT 118ackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: ;(dental,medical,animals, mortuary, <br /> !hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <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: 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 /> ECTRICA. PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: rG ,Z � Completed By: Date: <br />