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Intake $ Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# R 22 I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone !G— <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bld /TI/ dd Re Size p 7&S6 Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories 2. Proposed No.of Dwelling Units: <br /> Basement RNo ❑Yes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction I(LC. Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load IiZL School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No WYes ❑Shell Only Calculated: Credit: <br /> Code Year 112021 2018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> INA <br /> Fire Sprinklers: Update Existing ❑New System El Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: $Z t tY jjQ,E Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: Update Existing 11New System [ Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: F%vzf_ <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br /> Add1 RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 415 OdD n q /,',( L2 I <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if.• <br /> []Sys Dev Eva[: <br /> Additional Notes: <br /> ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: ❑Site Work/Drainage(shownitriggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary,hospital,supportive housing) <br /> SZFtre Sprinklers ElFire 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#: 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(join with this folder for permit issuance) <br /> Approved By^ t 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: lCompleted By: Date: (Uri 4w-2 <br />