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Intake &Approval Sheet (FOR PERMIT STAFF ONLI) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: D`63cn Date: « dam. 2024 <br /> Intake Comments: Intake Comments: <br /> Zone —1 <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> Bidg/TI/Addn/Rem Size ?,S I Sk T.1 Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use SF& <br /> Number of Stories ! Proposed No.of Dwelling Units: <br /> Basement No []Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction 1 (Lc Planning/Landscape Inspection Required before Final? ❑Yes Wo <br /> Occupancy Group R-C "in Lieu"Fee:Type: Amount$ �A <br /> Occupancy Load RC School Impact Fee: Total $ 0 IA <br /> Cert. of Occpuancy Required? El No []Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1112021 IR2018 112015 ❑Everett School Dist ❑Mukiiteo School Dist <br /> Fire Sprinklers: []Update Existing ❑New System NNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ r4 A (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: I�1 <br /> RCW 64.55 MF worksheet req'd for permit? []Yes El No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ (,VQ <br /> Approved By: Date: J" 247Af <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PINReview&Worksheet Needed Ff.• <br /> []Sys Dev Eval: <br /> ❑Water []Sewer []Storm <br /> Additional Notes: <br /> []Traffic Mitigation Eval <br /> Approved B Date: Z j 2_0Gy ❑Site Work/Drainage(shown/triggered) <br /> []Address Letter <br /> FIRE DEPARTMENT []Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: 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: ❑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(loin with this folder for permit Issuance) <br /> Approved By: Date: ❑Will be issued Separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> 19 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: ate: J1 1,591 <br />