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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# tO ( - 0 S$ <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone MO <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use i <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑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? 5-No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year ❑2021 P2018 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing Blew System I,[-Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: t� Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System iiNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ®No <br /> Add!RCW 64.55 docs required prior to final? ❑Yes 153-No additional otes4 Da �� I 1 <br /> VALUATION CALCULATION: Total$ 11 11FJ (/„ �jJ(/` l <br /> Approved By: Date: / <br /> PUBLIC WORKS . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ' ,j❑Sys Dev Eval: <br /> Additional Notes: vo• <br /> I OWater ❑Sewer I�Sform <br /> WNLL <br /> 1 DTraffic Mitigation Eval <br /> Approved By: a.i hGa. Date: )11 !Mite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> i <br /> FIRE DEPARTMENT ;DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: i(dental,medical,animals,mortuary, <br /> Se <br /> p q hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: 1 <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 /> i4Ainimal or No Fire Scope-NO FIRE FEEK 0 Is located In this folder <br /> Review/Inspection Scope ADD FIRE FEE 0 Is in a Separate Green Folder 0o1n with this folderfor permit Issuance) <br /> Approved By:Y, t (u.n Date: )-3 b y ❑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, j y /` 0 t.t.4.0Date: GO ij , Jz,`/ <br />