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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 /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <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 ONO <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occppancy R wired? ❑No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1-12021 ❑2018 02015 ❑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 El Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? LYYeS ❑No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ `-Ik1, S 3 1 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> IntakeComments: ...-".--._._..,,_._.,...,..,...___..,._____,._..,.,_...,_..._.._,.___.. <br /> PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: []Water ❑Sewer ❑Storm <br /> DTrafflc Mitigation Eval <br /> Approved By: ��� Date: - ?3 `[]Site Work/Drainage(shown/triggered) <br /> i <br /> i DAddress Letter <br /> FIRE DEPARTMENT jl]Backflow Prevention for high hazard: <br /> .(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: .hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm []Other: I <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 Goinwith this tolderfor permit issuance) <br /> Approved By: Date: ❑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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: ' <br /> Approved By: Date: Completed By: Date: <br />