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Intake $ Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1624Q�-- 02 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ( Overlay/Agreement Stdcwat� <br /> ❑ Make this a"W"Permit ❑ SRC Required Pre-Insp) <br /> Bldg/TI/Addn/Rem Size Nonresidential Use N /k <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑ s, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes PNo <br /> Occupancy Group "In Lieu"Fee:Type: Amounta1jL� <br /> Occupancy Load School Impact Fee: Total $ <br /> Cart.of Occpuancy Requir ?REE-1202i <br /> Only Calculated: nl la Credit: N1 lr <br /> Code Year Na❑2018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑ date Existing ❑New System El Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprin rs Required: Park Impact Fee Total$ NI A (net due after credit for existing uses) <br /> Fire Alarm, ❑Update Existing ❑New System []Not Req'd Fee Schedule Used For Calculation(Year): W ias <br /> Reason' ire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br /> dd'I RC 64.55 docs required prior to final? ❑ SCNe(r,0Q 0 NP <br /> Yes ❑No Additional Notes: ?.Otr6 Oyc a <br /> i0 CW*is it gyvpe-r�ttrw--& <br /> VALUATION CALCULATION: Total$ ZZ } S <br /> s p q Approved By: Date: 20 <br /> PUBLIC WORKS <br /> Intake OK by: Date: -- <br /> Intake Comments: PW Review&Worksheet Needed if., <br /> []Sys Dev Eval: <br /> 5�rro Lt)a, ❑Water ❑Sewer` Storm <br /> Additional Notes: /+ �8 <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: 3 / � � ❑Site Work/Drainage(shovm/triggered) <br /> at <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm []Other: <br /> - <br /> Additional Notes: his 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(join%-Ath this folder for permitissuance) <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 B . Date: �j <br />