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-OWLS I o ro a-f( V <br /> Intake $ Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT## f 30 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: (f 2 <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 Its <br /> Number of Stories Proposed No.of Dwelling Units: p <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$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No ❑Yes ❑Shell Only Averett <br /> ulated: Credit: <br /> Code Year ❑2021 02018. ❑2015 School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing El 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? ❑Yes ❑ No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: / <br /> VALUATION CALCULATION: Total$ <br /> Approved By. v Date: -1 tt Z <br /> l <br /> t' 0 �j k� PUBLIC WORKS <br /> t~�1 Intake OK by: <br /> Intake Comments: PW Review&Worksheet Needed If: <br /> []Sys Dev Eval: <br /> Additional Notes: <br /> ❑Water []Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: % Date: []Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> hospital,supportive housing) <br /> El 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 M 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(loin with this folder for Permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> r�v(t utn <br /> Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PL UMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Icompieted By: Date: 0111� I�Z <br />