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q11 ►1� 1�PP Qo (ler�l f <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # E Z46 - I bp <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/fl/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ElYes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occ uancy Required? <br />❑No OYes ❑Shell Only <br />Code Year 1112021 112018.112015 <br />Fire Sprinklers: ❑Update Existing ❑New System ❑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? DYes ❑No <br />Addl RCW 64.55 dots required prior to final? DYes ONO <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />017heSprinklers ❑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 />ELEGTRICAL/P. LUMBING <br />w <br />Notes:By: Date: 3 / 20 2 <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? DYes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukllteo School Dist <br />Park Impact Fees for permits applied for after 1M12022: <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: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PWReview& Worksheet Needed if: <br />I]Sys Dev Eval : <br />OWater ❑Sewer OStorm <br />UTmffic Mitigation Eva[ <br />[]Site Work/Drainage (shown/triggered) <br />17Address Letter <br />ElBackffow 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 gain with this folderforpenn¢issuance) <br />❑ Will be issued separately (Separate Green Folder, PIN Issued ahead of Bldg) <br />❑ Public Works has no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed By: Date: <br />