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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />.� PERMIT # SC;2­40l <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />BldglTl/Addn/Rem Size <br />IS0 S 51 <br />Garage/Accessory Struct. Size <br />t J A �p p 352 <br />Number of Stories <br />B ' w •r <br />Basement <br />❑No Ryes, Fin Unfi <br />Type of Construction <br />O <br />Occupancy Group <br />L <br />Occupancy Load <br />Cert. of Occppancy Required? <br />RNo ❑Yes []Shell Only <br />Code Year <br />102021 S2018 ❑2015 <br />Fire Sprinklers: []Update Existing ❑New System RNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing ❑New System ®Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No <br />Add'I RCW. 64.55 docs required prior to final? ❑Yes HNo <br />VALUATION CALCULATION: Total $ 5 Da®" <br />Additional Notes: <br />Approved By: �,, Date: 2 ®y Za <br />FikE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm []Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICALIPLUMBING <br />Additional Notes: <br />Approved By: Date, <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />, 2 <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Yj <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes o <br />"in Lieu" Fee: Type: Amou <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo Schoc ist <br />Park Impact Fees for permits applied for after 112022: <br />Park Impact Fee Total $ (net d7kor credit for existing uses) <br />Fee Schedule Used For Calculation (Year), <br />Additional Notes: <br />Approved By: Date: <br />rs; <br />PUBLIC WORKS <br />Intake OK by.' Date: <br />Intake Comments: PWReview & Worksheet Needed if: - -� <br />❑Sys Dev Eval : <br />❑Water ❑Sewer []Storm <br />I DTraffic Mitigation Eval <br />113Sits Work/Drainage (shown/triggered) <br />(I]Address Letter <br />6 <br />t <br />(❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />ihospital, supportive housing) <br />i <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit#: PW ) <br />AND ❑ Is fully digital <br />❑ Is located In this folder <br />El Is in a Separate Green Folder Qoin with this folderfor permit Issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />91?ublic Works has. no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed By: Date: ?,,.7eq <br />,21 <br />aE <br />