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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# F)Z IV 3-07g <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 Lo L-) I Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No. of Dwelling Units: <br /> Basement D,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 QYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 ❑2018 1:12015 ❑Everett School Dist Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑trot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System ❑'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 does required prior to final? []Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> 11t'ot,V1 OWeIIIn, ION SF Ji bG= 33,494- Approved By: f-o,/ DO Date: _ <br /> yAraye 4v55F Xf 25,92O <br /> covcrcd parch 24SF A4 6 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if. <br /> 06ys Dev Eval: <br /> Additional Notes: „ � r �icc�e5 QWaler OSewer Eastorm <br /> Approved B TQTraffic Mitigation Eval <br /> Date: ( ���uu`�" Z <br /> Y ✓ _ � Z -2 E]Slte Work/Drainage(shovm/triggered) <br /> IMAddress Letter <br /> FIRE DEPARTMENT I E]Backflow Prevention for high hazard: <br /> ISeparate/Deferred Submittals Required: (dental,medical,animals,mortuary, <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: dA Separate PW Permit is Required(Permit#1: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> 16 <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 Qoin vrith 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: Completed By: Date: / -U <br />