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Intake & Approval Sheet (FOR PERMIT STAFF ONLr PERMIT # FW 310 — 0 34- <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 />no GN14 Hl� <br />Garage/Accessory Struct. Size <br />Number of Stories <br />-f- 97o2 c Pk <br />Basement <br />❑No FrYes , Fi / Unfin <br />Type of Construction <br />t L <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />17No ❑Yes ❑Shell Only <br />Code Year 1112021 2018 112015 <br />Fire Sprinklers: ❑Update Existing ❑New System 13Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System 19 Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes allo <br />Add'[ RCW 64.55 docs required prior to final? []Yes ©No <br />VALUATION CALCULATION: Total $ 0UV <br />Additional Notes: <br />Approved By: 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 />,. �.ELECTRICAC/P.LUMBING <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 />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: / 2 av2.�? <br />PUBLIC WORKS <br />Intake OK by: Date: _ <br />Intake Comments: PW Review & Worksheet Needed if.• <br />❑Sys Dev Eval : <br />❑Water ❑Sewer ❑Storm <br />❑Traffic Mitigation Eval <br />❑Site Work/Drainage (shown/triggered) <br />❑Address 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 Coin 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: Inlit <br />