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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Ec?0 q-©?� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: VI% Date: i 0 4 Ion <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement ,., <br /> Bldg/TI/Addn/Rem Size I $5 Nonresidential Use off €t+ <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories ( Proposed No.of Dwelling Units: <br /> Basement ®No ❑`Yes , Fin/Unfin Total No.of Dwelling Units: <br /> �/Type of Construction t Planning/Landscape Inspection Required before Final? ❑Yes ►=No <br /> Occupancy Group i3 "In Lieu"Fee:Type: Amount$ *lift <br /> Occupancy Load b3 School Impact Fee: Total $ a IA <br /> Cert.of Occpuancy Required? ❑No glYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing El New System INot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 4 1 A (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing DNew System IZINot 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 does required prior to final? ❑Yes 111No Additional Notes: <br /> VALUATION CALCULATION: Total$ A Qua <br /> Approved By: 4.14.0,,,,,a Date: et Otkob,1 94 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: IPW Review&Worksheet Needed if: <br /> i Dsys Dev Eval:❑ ❑ <br /> Additional Notes: 11III Water DSewer Storm <br /> I©Traffic Mitigation Eval <br /> I <br /> Approved By: C I in_ Date: (1 ) 1-3 I Dsite Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT jOBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: hospital, <br /> medical,pr animals,houi mortuary, <br /> hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm ❑Other: I <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 0 Is located in this folder <br /> 171 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder coin with this folder for permit issuance) <br /> Approved By: -(f y' 's,12j Date: IV�,Z3 El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> \ Rut <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 Date: /0/2/23 <br />