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Intake &Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: % Date: <br /> Intake Comments: Intake Comments: <br /> Zone (L' <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bldg/Tl dd /Rom Size r b s Nonresidential Use <br /> Garag ccessory Struc ize j s Residential Use \1 S$ <br /> Number of Stories Z 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 Nvo <br /> Occupancy Group L "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ IX <br /> Cert.of Occpuancy Required? ❑No 0yes ❑Shell Only Calculated: Credit: <br /> Code Year 102021 P 2018 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System IgNot 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: El Update Existing ❑New System Kj Not Req'd Fee Schedule Used For Ca culation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 10 No <br /> Add'I RCW 64.55 does required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total$ Z <br /> OO <br /> fe IDS (j f IV)( t k �;20,17d Approved By: Date: 1 Z- .-'Z <br /> PUBLIC WORKS <br /> Intake OK by: Date: It 1712.13 <br /> Intake Comments: PW Review 6 Worksheet Needed if., <br /> wlblu IASys Dev Eva[: <br /> Additional Notes: prove�f -A- ����1401.5 .,' <br /> {t !1AwV ❑Water ❑Sewer I�Storm <br /> �w Wr <br /> OO,„ ❑Traffic Mitigation Eval <br /> Approved By: Date: ) y }, � `�►�"' ❑Site Work/Drainage(shown/triggered) <br /> 11 1" ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals <br /> Separate/Deferred Submittals Required: mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: VM This Permit is Approved by Public Works <br /> 0 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 goin vvith this folder for 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: lCompleted By: Date: `j '2,b /�6 Z <br />