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Intake & Approval Sheet <br />(FOR PERMIT STAFF ONLY} <br />PERMIT #_�14 U <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bld I ddn/Rem Size <br />0-7 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />IRNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />No ❑Yes ❑Shell Only <br />Code Year <br />1 P92021 112018. 132015 <br />Fire Sprinklers: IflUpdate Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: 19 Update Existing ❑New System []Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 1�1 No <br />Add'] RCW 64.55 docs required prior to final? ❑Yes RNo <br />VALUATION CALCULATION: Total j3 D <br />Additional Notes: <br />Approved By: t Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />sprinklers Eire 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:Kcz;�Date: 5�� <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To:� eSS Date: 2S <br />Intake Commen <br />Zone <br />�ZZ <br />Overlay/Agreement <br />A 1 A } AC A <br />Nonresidential Use <br />'War• ern o use at- a q-�tc.e%S <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes PgNo <br />"In Lieu" Fee: Type: Amount $ 0 <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park Impact Fee Total $ (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: no Charmf- ton v5e so n(D lieS assesse <br />Approved By: Date: 5 Z 8 Z-i <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Review 6 WorksheetNeeded if: <br />[]Sys Dev Eval : <br />❑Water []Sewer []Storm <br />(]Traffic Mitigation Eval <br />[]Site Work/Drainage (shown/triggered) <br />ClAddress Letter <br />❑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 Qoln with this folderfor permit issuance) <br />❑ WIII be issued separately (Separate Green Folder, PW Issued ahead of Bldg) <br />® Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />►KAKI, rlb cA & 0(t 4t W <br />Com pletedd By: Date: <br />