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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# o <br /> _" <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK byAL_ <br /> Assign To:j e5S Date:? 1 -LL I <br /> Intake Comments: Intake Comm <br /> Zone <br /> ❑Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement NIA <br /> Bldg[TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use M u I i �ctrn A <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes &No <br /> Occupancy Group "in Lieu"Fee:Type: Amount$ Q <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occppancy Required? ❑No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1112021 ❑2018. 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 111/2022: <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 ❑No <br /> Add'I RCW 64.55 docs required priorto final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> Approved By: Date: 7�11�Zc <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PWReview b WorksheetNeeded i. <br /> []Sys Dev Eval <br /> F <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> a <br /> OTraffc Mitigation Eva <br /> Approved By: te: 0Site Work/Drainage(shown/triggered) <br /> 1I]Address Letter <br /> FIRE DEPARTMENT W1 y(/►pjj�"°`�' IN 3E]Backflow Prevention for high hazard: <br /> =(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: ® 1hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: j <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/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(ioln with this folderfor permit issuance) <br /> Approved By: Date: ❑WIII be issued separately(Separate Green Folder,PW Issued ahead of Bidg) <br /> NPublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAIJPLUMBING Additional Notes: / <br /> Additional Notes: I vV'D\0)- A0 S <br /> Approved By: Date: Completed By: Date: 1 1 p <br />