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Intake &Approval Sheet !JIDR PERMIT STAFF ONLY) I LIMIT# 23Oc( i 67 1 <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 0 SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/Tl/Addn/Rem Size '3L9 Nonresidential Use <br /> Garage/Accessory Struct.Size , Residential Use <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement lNo ❑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 it9 School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ONo IYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 1E2018. 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ®New System ❑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: El Update Existing 5L1New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: ��ryry <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes E7 No <br /> Add'I RCW 64.55 docs required prior to final? DYes INo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> l rJ Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> iDSys Dev Eval: <br /> ( ❑Water ❑Sewer ❑Storm <br /> Additional Notes: [ <br /> I ElTraffic Mitigation Eval <br /> Approved By: �� Date: 3 lt(/_u €CDSite Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT 1UBackflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: 'hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm El Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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 0 Is located in this folder <br /> ❑Review/Inspection Scope-ADD FIRE FEE D Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: 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 />