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Intake $ Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement r <br /> Bldg/TI/Addn/Rem Size 7- (JZ Nonresidential Use <br /> Garage/Accessory Struct.Size y-o Residential Use ) <br /> Number of Stories "L Proposed No.of Dwelling Units: / <br /> Basement QNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: I <br /> Type of Construction -t 1 Planning/Landscape Inspection Required before Final? es ❑No <br /> Occupancy Group "In Lieu"Fee:Type: — Amount$ <br /> Occupancy Load School Impact Fee: Total $ // Z/ <br /> Cert.of Occpuancy Required? []No Yes ❑Shell Only Calculated: // I/ Credit: — <br /> Code Year I❑2021 [02018. ❑2015 ❑Everett School Dist ffMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System QNot 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 Not Req'd Fee Schedule Used For Calculation(Year). G L ^" <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 19 No <br /> Add'I RCW 64.55 docs required prior to flnal? ❑Yes CoNo Additional Notes: <br /> VALUATION CALCULATION: Total$ :57 Ar -0 <br /> Hudson" pole k!Y\g— ZIoZ 5 K n $I6=f 341.Ml- Approved By: Date: <br /> 43oSF R 044f i is <br /> (,, e Pam— 14 S F �( � , $dl'` 9{, PUBLIC WORKS <br /> bo;Wng rvlewur I-o vr�� 43113 Intake OK b <br /> � 9t : Date:Y—�-- <br /> Intake Comments: v PWRevlew&Worksheet Needed If. <br /> J r/C> 'Do Y66 '- OSys Dev Eval: <br /> Additional Notes: rDuh� . {Water \o(Sewer�Storm <br /> &S `f' <br /> 3� 'A'/ Traffic Mitigation Eval <br /> luv� C!�'7 <br /> L!� <br /> Approved By: ' Date: �� ,N� Site Work/Drainage(shown/triggered) <br /> PrV Z�i��,�(� Address Letter <br /> FIRE DEPARTMENT I v ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals mortuary, <br /> p q hospital,supportive housing) <br /> Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: This Permit is Approved by Public Works <br /> a-See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: A Separate PW Permit is Required(Permit#: PW ZS ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Is fully digital <br /> R Minimal or No Fire Scope-NO FIRE FEE s located in this folder <br /> ❑Review/Inspection Scope-ADD FIRE FEE tis in a Separate Green Folder Qotnvrith this fotderfor permit Issuance) <br /> Approved By Date•'3— - L 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: . 0` 7 <br />