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Intake & Approval Sheet l� I (FORCPEERMIT STAFF ONLY ) PERMIT# y, - 01 I <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/TI/Addn/Rem Size J-30 Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No. of Dwelling Units: <br /> Basement EINo ['Yes , Fin /Unfin Total No. of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu" Fee: Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? ❑No Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 1112018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: Pupdate Existing ❑New System CI Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: Update Existing El New System El Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes q,No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total $ `Al't DOS <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> I❑Sys Dev Eval : <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: (,, �` �,� Date: kill l •N, f❑Site Work/Drainage(shown/triggered) <br /> !❑Address Letter <br /> i <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: !(dental, medical, animals,houi mortuary, <br /> !hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> ❑ 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 ❑ Is located in this folder <br /> 3 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:. ,coGcn Date: ❑ 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 />