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Intake & Approval Sheet (FOR PERMIT STAFF ONLV) PERMIT # 16740!�'00(0 <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bld /TI ddn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />l <br />Basement <br />QNo ❑Yes , Fin / Unfin <br />Type of Construction <br />PC, <br />Occupancy Group <br />t PC — <br />Occupancy Load <br />j CL✓ <br />Cert. of Occpuancy Required? <br />No ❑Yes ❑Shell Only <br />Code Year <br />Q 2021 ❑2018 112015 <br />Fire Sprinklers: ❑Update Existing El New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System Rrmot 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 No <br />VALUATION CALCULATION: Total $ <br />Additional Notesfirafp,1j 9ZA0DjL, )�41 PP O dr <br />la)i- " Nfto 2X , Pa RS <br />Approved 13y:hNhLCMM Date: <br />FIRE 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 />ELECTRICAL/PLUMBING <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 />Nvi*yI &jrOl/29`t "*rf(-0AekL <br />Nonresidential Use <br />Residential Use <br />Sri? - <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: s-Z3 ZO <br />PUBLIC WORKS <br />Intake OK by: Date: <br />.. ..... ._...._.............................. ____..........__. _... �.. �... <br />Intake Comments: PW Review & Worksheef Needed if.• <br />I❑Sys Dev Eval <br />❑Water ❑Sewer ❑Storm <br />❑Traffic Mitigation Eva[ <br />I ❑Site Work/Drainage (shown/triggered) <br />E (]Address Letter <br />I <br />I ❑Backflow Prevention for high hazard: <br />;(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 />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder (Join with this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />List Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: V- Date: b-9 <br />p b tie2 <br />