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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �-4° Z - 0 7 y <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 1,/1 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size (�e Nonresidential Use -- <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories ALL Proposed No.of Dwelling Units: / <br /> Basement PNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction _Z Planning/Landscape Inspection Required before Final? ElYes ❑No <br /> Occupancy Group o/ "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load ' School Impact Fee: Total $_ // c <br /> Cert.of Occpuancy Required? ❑No ' Yes ❑Shell Only Calculated: Credit: <br /> Code Year 102021 2018. ❑2015 ❑Everett School Dist Mukilteo School Dist <br /> Fire Sprinklers: []Update Existing❑New System QNot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ T?_?/ (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System lot Req'd Fee Schedule Used For Calculation(Year): 2 <br /> Reason Fire Alarm Required: 1�t <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 19 No <br /> Add']RCW 64.55 docs required prior to final? ❑Yes ` No Additional Notes: A)- <br /> VALUATION CALCULATION: Total$ <br /> ki LO tVIOVI" D we— I hq N;�l SF x f Ib6'312,10 Approved By: �� Date: - i e/- Z� <br /> �alray� J �Z4sr- ;K4;V+ ,(3� <br /> co ve rcd porc t'► 'I-1 S F A 64 PUBLIC WORKS <br /> BtAtldih9 YC6tw" h) 34Z,00( Intake OK by: Date: <br /> Intake Comments: A � PW Review&Worksheet Needed if., <br /> �" Fee 1t Sys Dev Eval: <br /> Additional Notes: (,�A �C�rA GAS (((`" 'Water RJgewer Storm <br /> c['aw t1 a de'r raffic Mitigation Eval <br /> Approved By: f Date: k' t,1 ��03-05 He Work/Drainage(shovmltriggered) <br /> W Address Letter <br /> FIRE DEPARTMENT ❑Backfiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> . 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 M PW <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> 2M]nimal or No Fire Scope-NO FIRE FEE is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE �U Is in a Separate Green Folder Coln with this fotderfor permit Issuance) <br /> Approved By: Date: _ El 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 />