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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# _.g ..L( v/ -0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: ( Date: <br /> Intake Comments: Intake Comments: <br /> Zone f Ytt) <br /> ❑Make this a"W"Permit 0 SRC Required(Pre-insp) Overlay/Agreement ` - <br /> Bldg/TI/Addn/Rem Size Nonresidential Use *&kio}i <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 2021 02018 02015 ❑Everett School Dist DMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing❑New System ( Not Req'd Park Impact Fees for pertrtits 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? ❑Yes El No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes J No Addition <br /> aIN1�ottees':1^I/1 ►/)1 VAL UATION CALCU[ATION: Total$ I I,o 0 ,�1 1 �► "' `�V)/ 2_I I I2_q <br /> Ai-proved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: t,,,/_,, - <br /> OWater ❑Sewer ❑Storm <br /> Y' J^('` DTraffic Mitigation Eva! <br /> 1/Approved By: L4 6 �.y Date: I// .L(. DSite Work/Drainage(shown/triggered) <br /> I/it <br /> IDAddress Letter <br /> FIRE DEPARTMENT l0Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <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: 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 ❑ Is located in this folder <br /> o Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder coin with this folder for permit issuance) <br /> Approved By. V.-.),CDwh Date: 1'—�0—,2.bI ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ORublic 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: _ i. y fpy P_ Date: o/1711 ao a 5/ <br />