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Intake $ Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# n - 003 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: jeSS Date: 2 <br /> Intake Comments: Intake Comme ts: <br /> Zone - <br /> ❑ Make this a"W" Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement tV A <br /> Bldg/TI/Acidn 1� ize t) S r Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use A F � <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement MNo ❑Yes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction - Planning/Landscape Inspection Required before Final? ❑Yes ®No <br /> Occupancy Group f "In Lieu"Fee: Type: Amount$O <br /> Occupancy Load - School Impact Fee: Total $Q <br /> Cert.of Occpuancy Required? ❑No MYes ❑Shell Only Calculated: Credit: <br /> Code Year %2021 112018 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System 15Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: I Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System CgNot 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 prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $ <br /> Approved By: Date:(o l7 Z Lj <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if., <br /> ❑Sys Dev Eval: <br /> Additional Notes: ul�_ ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eva[ <br /> Approved By: Date: ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backllow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Se <br /> p q hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <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 /> fi�Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br /> Approved By: K Dater- / y ❑ 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:06102, � <br />