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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 <br /> Bldg[TI/Addn/Rem Size A V r Nonresidential Use /tom <br /> Garage/Accessory Struct, Size Residential Use ` <br /> Number of Stories Z Proposed No.of Dwelling Units: <br /> Basement o ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction 'LZ L Planning/Landscape Inspection Required before Final? IffYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: — Amount$ <br /> Occupancy Load t School Impact Fee: Total $ / <br /> Cert.of Occpuancy Required? ❑No t4Yes ❑Shell Only Calculated: Credit: �- <br /> Code Year 112021 E12018. 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System qNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ .3 ��Z_(net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System gNot Req'd Fee Schedule Used For Calculation(Year): r,?U Z <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 RNo Additional Notes: <br /> VALUATION CALCULATION: Total$_ ILL,Off <br /> _ <br /> hclt,h l7WCjlin 2004SF x#1w,-333,49+ Approved By: -' <br /> crag e +0 5 5 F x f, Z5,9 2a y Date: z <br /> (�vt;rcol porch 245E ><4 1,53b <br /> �jbkk"ltl'in9 t tG ltWtr � quri-j� �JtO(71 q 5� PUBLIC WORKS <br /> 111""" Intake OK by: Date: <br /> Intake Comments: PIN Review 6 Worksheet Needed ff.• <br /> �&f 5 PC V�-ee- OSys Dev Eva[: <br /> Additional Notes: r it O vu(fo ez S )]Water V)Sewer NStorm <br /> GGf/Q SJ C&J Traffic Mitigation Eval <br /> A V <br /> Approved By: Date: uN l ��2 3 a 3 0\l S Site Work/Drainage(shown/triggered) <br /> Si-f� ��u`'�J Address Letter <br /> FIRE DEPARTMENT L ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Fire Sprinklers ❑Fire Alarm ❑Other: hospital,supportive housing) <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: L/N-A Separate PW Permit is Required(Permit#:PW 040,j- 0014) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> Minimal or No Fire Scope-NO FIRE FEE P9 Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Qoln with this folder for permit issuance) <br /> Approved By: Date: -13 ❑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 />