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l?Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# $c 11 O("" 0 g <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ,)J <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> BldgiTI/Addn/Rem Size Nonresidential Use { "' , <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No DYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ['Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? CNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 432018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ITINot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System E Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? Oyes El No <br /> Add'I RCW.64.55 docs required prior to final? ❑Yes ❑No Additio a Notes: n ' / <br /> VALUATION CALCULATION: Total SQL Cp�'�1 1/U�X/l 1 <br /> Approved By: Dat I <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if:: <br /> ❑Sys Dev Eva!: <br /> •Additional Notes: VIA/9 t /�� ❑Water ❑Sewer ❑Storm <br /> L.�V V' [(Traffic Mitigation Eval <br /> I <br /> Approved By: t,rifm,I\,c.,. Date: (I ).)4 4DSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIR1~ DEPARTMENT IDBackflow Prevention for high hazard: <br /> • <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <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 0 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: k.cp(N,n Date:1_9„0 '"1 ❑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 /> • <br /> Additional Notes: <br /> Approved By: Date: Completed By: Ah 7 e ,J� Date: /3 I /20 l y <br />