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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# di Q 65 <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: intake Comments: <br /> Zone Oft t U <br /> 0 Make this a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement • <br /> Bidg/TI/Addn/Rem Size Nonresidential Use q -Vier <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> • <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "1n Lieu"Fee:Type: Amount$ <br /> Occupancy Load School impact Fee: Total $ / <br /> Cert.of Occppancy Required? No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 2021 va2018 ❑2015 [(Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:❑Update Existing Mew System INot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ ' V (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System ciNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I No <br /> Add!RCW.64.55 docs required prior to final? ❑Yes No (Additional Notes: /� 1n/o II <br /> VALUATION CALCULATION: Total$ t t 1 S Ob Gu��g J%. 24,: 2 . <br /> ltr <br /> proved By: Date: <br /> PUBLIC WORKS . <br /> Intake OK by:`: Date: <br /> Intake Comments: PW Review&Worksheet Needed ff. <br /> • ,'❑SysDev Eval: <br /> Additional Notes: ❑Water ❑Sewer OStorm <br /> � � I❑Traffic Mitigation Eval <br /> Approved By: C,,itleA.N,AA Date: 1,1(1)_N jMSite Work/Drainage(shownitrfggered) <br /> IDAddress Letter <br /> f <br /> FIRE DEPARTMENT ;OBackflow Prevention for high hazard: <br /> • '(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> Ihospltal,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm ❑Other: I . <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> . 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#:PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> l Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑Review/Inspection Scope-ADD FiRE FEE 0 Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: \9j.(-v(,476-\Date: \—?)Q"„24 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> gPublic Works has.no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING Additional Notes: <br /> • <br /> Additional Notes: <br /> Approved By: Date: Completed By:Aty / 76' <br /> ejo <br /> Date: 0I f 11I 7, 24 <br />