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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1 0(---(:)5 q <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone mu <br /> ❑ Make this a"W"Permit 0 SRC Required (Pre-Insp) Overlay/Agreement <br /> Bidg/TI/Addn/Rem Size Nonresidential Use l ' on <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? No DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 E12018 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: ❑Update Existing El New System lNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? oyes rp No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ITI'No Additional►Notes: / <br /> VALUATION CALCULATION: Total$ (it c V �� /emu Y 1I( O,L- <br /> W VI/7 q • <br /> Approved By: Date: 111 <br /> PUBLIC"WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if. <br /> '❑Sys Dev Eval: <br /> Additional Notes: tWL.(r v OWater ❑Sewer ❑Storm <br /> N" I(]Traffic Mitigation Eval <br /> Approved By: G ‘cot LA Date: ).h'/1.u1 IOSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT . OBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dhosentalpital,,medical,supportive animalsh ,ousin mortuaryg) , <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: I <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 /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit Issuance) <br /> Approved By:\.:Q)cbu Date: \-, b,_y 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 1 11 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:4/7----ge,. 1i, Date: nfl . ) I?,0Zu <br />