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Intake Approval Sheet (FOR P ttilLtb& ( R ERMIT STAFF ONLY PERMIT# DST) <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-Insp) Overlay/Agreement <br /> Bldg/Tl/Addn/Rem Size gm/cc Nonresidential Use <br /> Garage/Accessory Struct.Size , Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement g.No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction ixr-( Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group g 5_ ( "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> pert.of Occpuancy Required? 'No ❑Yes ❑Shell Only_ Calculated: Credit: <br /> Code Year Z2021 02018. 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: OUpdate Existing ❑New System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: itr.. "(J f)7 i1J_1O Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: iJpdate Existing LI New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: cc'f c. I Nriq-t P <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 FJo Additional Notes: <br /> VALUATION CALCULATION: Total$ I/0, U • - <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: [ WReview&Worksheet Needed if: • <br /> (]Sys Dev Eval: <br /> Additional Notes: <br /> ❑Water OSewer ❑Storm <br /> IDTraffic Mitigation Eval <br /> Approved BP !' '! Date: 417.0 ,)]Site Work/Drainage(shown/triggered) <br /> 1]Address Letter <br /> FIRE DEPARTMENT IDBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: :hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: 0 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(loin with this folder for permit issuance) <br /> Approved By: l „I�� Date: g 2,24/ . ❑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: Date: <br />