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Intake & Approval Sheet (FOR PERMIT STAFF ONLIO PERMIT # 62`T04-" 00 <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 />Rerw t(/ <br />Garage/Accessory Struct. Size <br />Number of Stories <br />✓ <br />Basement <br />[]No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />1! <br />Cert. of Occpuancy Required? <br />KINo ❑Yes ❑Shell Only <br />Code Year <br />2021 112018 02015 <br />Fire Sprinklers: ❑Update Existing ❑New System Clot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System Mot 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 ISNo <br />VALUATION CALCULATION: Total $ te O <br />Additional Notes: �N9v �` dYtGtS <br />Approved By: Date: <br />u <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/PLUIYABING, <br />Additional Notes: <br />Approved By: Date: <br />�� PLANNING 4 <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />R 2 <br />Overlay/Agreement <br />Stc►ewcdk %/z Mi1G C& <br />at <br />Nonresidential Use <br />µ <br />Residential Use <br />St <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: N/IN Amount $ NIA <br />School Impact Fee: Total $ <br />Calculated`. hlI I� Credit: N/A <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ i Ik (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): N/A <br />Additional Notes: <br />Approved By: Date: Qfl22 Zo2Z{ <br />V <br />Pt$gLIC 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 Eva[ <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 (join with this folderfor permit issuance) <br />Will 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: <br />ate: G� <br />LIM <br />