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Intake & Approval Sheet �. ,JR PERMIT STAFF ONL1) <br />'RMIT# aca <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />BldgTrl/Addn/Rem Size <br />3 r <br />GaragelAccessory Struct. Size <br />Number of Stories <br />Basement <br />IRNo OYes, Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />°( <br />Cert. of Occpuancy Required? <br />IgNo ❑Yes '❑Shell Only <br />102021 <br />Code Year <br />L,2018 132015 <br />Fire Sprinklers: ❑Update Existing ❑New System ®Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ®Not Req'd <br />Reason Fire Alarm Required: - <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 1B No <br />Add1 RCW 64.55 docs required prior to final? ❑Yes 19No <br />VALUATION CALCULATION: Total $ 101000 <br />Additional Notes: <br />Approved By: ;� Date: 0111�. <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 />ig-Review / Inspection Scope - ADD FIRE FEE <br />Approved By: �-0Date: — <br />ELECTRICAL/PLUMBING._ <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: 3eS5 Date: IZ 13 Z 3 <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Ac-A -t AIN <br />Nonresidential Use <br />HeavL6 i�cws�lr'ta\ <br />Residential Use <br />1J/A <br />Proposed No. of Dwelling Units: <br />NJA <br />Total No. of Dwelling Units: <br />N A <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No' <br />"In Lieu" Fee: Type: Amount $ CD <br />School Impact Fee: Total $ 0 <br />Calculated: Credit: <br />[]Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees forpermitsapplied for after 1/1/2022: <br />Park Impact Fee Total $ C(net due after creditiforexisting uses) <br />J <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: 1 Z 113 3 <br />U <br />PUBLIC'WORKS <br />Intake OK by: Date: <br />Intake Comments: PIN Review & Worksheet Needed if.•� <br />❑Sys Dev Eva[ : <br />❑Water ❑Sewer ❑Storm <br />OTraffic Mitigation Eval <br />❑Site Work/Drainage (shown/triggered) <br />(]Address Letter <br />❑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 t PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder Goin with this folder for permit issuance) <br />❑ WIII 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: /,'� 81 20 Zj <br />