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Intake & Approval Sheet (FOR PERMIT STAFF ONL) <br />r"RMIT # b2 110 - 03 <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑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 />❑2021 ❑2018. ❑2015 <br />Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []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 ❑No <br />VALUATION CALCULATION: Total $ <br />�1VIV7 <br />Additional Notes: MWK <br />Approved By: LAL Date: Y11 <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 />Nonresidential Use <br />Residential Use <br />_-'rp1'""C> <br />Proposed No. of Dwelling Units: <br />i i <br />Total No. of Dwelling Units: <br />1 Z. <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 1/112022: <br />Park Impact Fee Total 2—Z (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: 3 20 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />.... ............ <br />....... <br />_.-......... <br />Intake Comments: PWReview & WorksheetNeeded if: <br />❑Sys Dev Eval <br />❑Water ❑Sewer ❑Storm <br />:]Traffic Mitigation Eva[ <br />I0Site Work/Drainage (shown/triggered) <br />EDAddress Letter <br />❑Backflow Prevention for high hazard: <br />F(dental, medical, animals, mortuary, <br />Ehospital, 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 Qoin with this folder for 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 />Completed By: Date: <br />