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Intake & Approval Sheet (FOR ,PERMIT STAFF ONLY) PERMIT if C 516 <br />131JILDING <br />intake OK by: pate:) <br />Intake Comments: <br />13 Make this a "W" Permit <br />❑ SRC Re ulred (pre -Ina <br />BldglTl/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />QNo ElYes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert, of Occpuancy Required? <br />BNo l_lyes UShell Only <br />Code Year <br />02021 [12018 [12015 <br />Fire Sprinklers: 0-update Existing EINew System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ElUpdateExisting []NewSystem LINotReq'd <br />Reason Fire Alarm Required: <br />ROW 64.55 MF worksheet req'd for perrriit? UYes 11 No <br />Add'I RGW. 64.68 does required prior to final? EIYes BNo <br />VAi:UATION CALCULATION: Total <br />Additional Notes: <br />�Approyed By: Date: 'q <br />E <br />FIRI'pI~PACTM�I�T' <br />Separate I Deferred Submittals Required: <br />❑Fire Sprinklers OFire Alarm []Other. - <br />Additional Notes: <br />Fire Dept. flees: <br />Review of As -Built Plans - NO FIRE FEE <br />�l Minimal or No Fire Scope - NO FIRE FEE <br />)=l Review/inspection Scope -ADD FIRE FEE <br />Approved By: pate: <br />ELI56T.R(CAL/PLUMBING <br />[Approved <br />dditional Notes: <br />By: Date: <br />NNiNC <br />Intake OK by: Assign To: Pta Date-JZ Afsil <br />intake Comments: <br />Zone <br />M <br />Overlay/Agreement <br />Nonresidential Use <br />t1dx t W <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />PlartninglLandscape Inspection Required before Final? 0Yes i�[No <br />"in Lieu" Fee. Type: Amount $ 01A <br />School Impact Fee: Total $ j k <br />Calculated: Credit: <br />DEverett School [Dist ElMukilteo School Dist <br />Parklmpact Fees for permits applied for after'11112022, <br />Park impact Fee Total $ t p (net due after credit far exf0bg uses) ' <br />Fee Schedule Used For calculation (Year): <br />Additional Notes: <br />Approved By: , Date: 12. W1 '� 2A <br />PUf3.L1C W0aK8 <br />Intake OK by: Date: <br />., . <br />Intake Comments: AW Revfe►�v & Worksheet Needed if• <br />_ <br />QSys Dev Eval <br />IQWater QSewer []Storm <br />10TrafriG Mitigation Eval, <br />F <br />USite Work/Drainage, (shown/triggered) <br />QAddress Letter <br />IQRackilow Prevention for high hazard: <br />`(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />F <br />Q This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />l� A Separate PW Permit is Required (Permit #: PW ) <br />AND Is fully digital <br />Is located in this folder <br />tat <br />1-1 Is in a Separate Green Folder Qorn-with thrafolderforpermit issuance) <br />Will be issued separately (Separate Green Folder, PW issued ahead of6idg) <br />Publio Works has•no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed I3y: <br />NW&VI Date: Q orl <br />?V <br />It <br />u <br />