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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# .6pot 05 2- <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone L.12 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size ). k'OQ Nonresidential Use 5110 lr . 4u0 <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement to DYes, Fin/Unfin Total No. of Dwelling Units: <br /> Type of Construction tki Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group f! "In Lieu" Fee:Type: Amount$ <br /> Occupancy Load 4U� School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? giNo DYes DShell Only Calculated: Credit: <br /> Code Year 02021 fil2018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑update Existing ❑New System l4Not 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 &Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? DYes INo <br /> Add'I RCW 64.55 docs required prior to final? DYes rgNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 0" � ��/� Q/1 ('13 <br /> Approved By:: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: ]PW Review&Worksheet Needed if: <br /> 1`❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: c.r.t. Date: MI i /.1 ❑Site Work/Drainage(shown/triggered) <br /> I❑Address Letter <br /> FIRE DEPARTMENT [❑Backflow Prevention for high hazard: <br /> [(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: [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 ❑ 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: V,bf2xr,/>7 Date:9-47f23 ❑ 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: ;r '7:‹e„,,,..44 Date: o R-7 . 23 <br />