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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />BUILDING <br />Intake OK by: < Date: ?/ <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />n/Rem Siz <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />RNo Yes , Fin / Unfin <br />Type of Construction <br />,❑r <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />❑No Wes ❑Shell Only <br />Code Year <br />021 112018 112015 <br />Fire Sprinklers: v4jpdate Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: pdate Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ITNo <br />Add'I RCW 64.55 docs required prior to final? []Yes <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: Date: <br />SepaOF <br />Addit <br />[Fire <br />El F <br />El <br />L�r <br />Add <br />API <br />PERMIT #J'�\7 . V `' <br />PLANNING <br />Intake OK by:-� Assign To: 25 Dater <br />Intake Commentsfr <br />Zone <br />M V <br />Overlay/Agreement <br />Ord. 2$Ka-05, pea • <br />Nonresidential Use <br />or beverage <br />Residential Use <br />^ <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />-- <br />Planning/Landscape Inspection Required before Final? []Yes E[No <br />"In Lieu" Fee: Type: Amount $ V <br />School Impact Fee: Total $ ('�' <br />Calculated: Credit: <br />El Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/112022: <br />Park Impact Fee Total $y (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date:rj 3 7-LA <br />v v <br />PUBLIC WORKS <br />Intake OK by: Date: <br />.,.,... ..... <br />.... <br />...... <br />..... <br />..... <br />.... <br />..... <br />.................. <br />............ <br />........... <br />.,,.,,..,,.............. <br />.... <br />..... <br />..... <br />...... <br />Intake Comments: PW Review & Worksheet Needed if: <br />I0Sys Dev Eval <br />I ❑Water ❑Sewer ❑Storm <br />OTraffic Mitigation Eval <br />F <br />IOSite Work/Drainage (shown/triggered) <br />❑Address Letter <br />I013ackflow 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 />❑ Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: Date: <br />