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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ��' <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by; Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bld Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement 4No ❑Yes, Fin l Unfin Total No.of Dwelling Units: <br /> Type of Construction � G Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group t "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert. of Occpuancy Required? ®No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 102018 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ®Update Existing ❑New System ❑Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System ®Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IgNo Additional Notes: <br /> VALUATION CALCULATION: Total$_ L� O�_ C Z <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: l.__...._.__.,,,.,_.,..,__,,..___...._.._....__.....___..._......_,._.._. <br /> PW Review&Worksheet Needed if., <br /> (❑Sys Dev Eval: <br /> Additional Notes: 1 ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eva[ <br /> Approved By: t' t Date: {d ` T n, Site Work/Drainage(shown/triggered) <br /> Address Letter <br /> FIRE DEPARTMENT !ElBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> (hospital,supportive housing) <br /> Sprinklers IRIFire Alarm ❑Other: 1 <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> Review[E /Inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder(join with this foiderfor permit issuance) <br /> Approved By: Date: WIII be ISSUed Separately(Separate Green Folder,PW issued ahead of Bldg) <br /> , 1 <br /> Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: Zff L <br />