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72 <br />Intake & Approval Sheet ( ? PERMIT STAFF 01WO F dIT # ;E�� 6 0� d 5( <br />BUILDING <br />Intake OK by: Date: <br />intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/AddnlRem Size <br />$F <br />Garage/Accessory Struct. Size <br />N/k �Z5 <br />Number of Stories <br />1 Yz v/ <br />Basement <br />[]No 1AYes , Fin 1 nfin <br />Type of Construction <br />Occupancy Group <br />1t� <br />Occupancy Load <br />Cert. of Occuuancy Required? <br />R[No []Yes ❑Shell Only <br />Code Year <br />102021 N2018 ❑2015 <br />Fire Sprinklers: ❑Update Existing 11New System WNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: OUpdate Existing []New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? 1 1Yes ® No <br />Add'I RCW. 64.55 does required prior to final? ElYes ARNo , <br />VALUATION CALCULATION: Total $ D — <br />��,� - COS O <br />Additional Notes: <br />Approved By: Date: <br />PII2)~ DEPARTMOTf <br />Separate I Deferred Submittals Required: <br />Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />11 Review of As -Built Plans - NO FIRE FEE <br />El Minimal or No Fire Scope - NO FIRE FEE <br />El Review / inspection Scope - ADD FiRE FEE <br />Approved By: Date: . <br />E,LEGTRICALII?LUMB.ING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />SCR <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />1 <br />PlanninglLandscape Inspection Required before Final? ❑Yes No <br />"In Lieu" Fee: Type: Amount $ <br />School impact Fee: Total $ <br />Calculated: Credit: GS <br />r <br />Everett School Dist E]Mukilteo School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park impact Fee Total (net due after credit for exlsGng uses) ' <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: Z 2-C 20" <br />PI <br />PU811-1 W®RIKS <br />Intake OK by: Date; <br />Intake Comments: IAw('e"'v"le"""w""'&""Workshost Needed if, <br />QSys Dev Eval : _ <br />} ❑Water L-.1Sewer 0Storm <br />IElTraffic Mitigation Eval <br />Mite Work/Drainage (shown/triggered) <br />f❑Address Letter <br />: <br />�Mackflow Prevention for high hazard: <br />i(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />El A Separate PW Permit is Required (Permitl#: PW ) <br />AND ❑ is fully digital <br />El Is located in this folder <br />Ells in a Separate Green Folder Qoinwiththis folderforpermit Issuance) <br />Ci WIII be issued separately (separate Green Folder, PW issued ahead of Bldg) <br />Q Public Works has. no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed By: Date: <br />