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Intake & Approval Sheet FOR PERMIT STAFF ONLr ERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction <br />V t <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />®No ❑Yes ❑Shell Only <br />Code Year <br />❑2021 22018 ❑2015 <br />Fire Sprinklers: ❑Update Existing ❑New System ®Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing ❑New System JR]Not Req'd <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 <br />VALUATION CALCULATION: Total $ %,X'I'- Z-oo <br />Additional Notes: <br />Approved By: Lt &A,•.M Date: o <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm []Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />eview / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />,2_3 i <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />El Everett School Dist ❑Mukiiteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ / (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Addition Notes:. <br />pproved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Cyr Date: Z2 <br />Intake Comments: PW Review & Worksheet Needed if: <br />�1 L []Sys Dev Eva I : <br />❑Water ❑Sewer ❑Storm <br />Traffic Mitigation Eval <br />Site Work/Drainage (shown/triggered) <br />[]Address Letter <br />!I []Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ Will be issued separately (separate Green Folder, PW issued ahead of Bldg) <br />MPublic Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: <br />Date: <br />I <br />