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Intake $ Approval Sheet t. JR PERMIT STAFF ONLY) _RMIT# ���( ✓'tea <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 k 5 p Nonresidential Use <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 /> Type of Construction V b Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group "in Lieu"Fee:Type: Amount$ <br /> Occupancy Load ;S School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ®No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year ❑2021 02018 112015 El Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: []Update Existing ❑New System 1,A Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System El Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: VP Qi,l(�C L )' D I`+'1�G1. USA 8 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes ©No Additional Notes, <br /> VALUATION CALCULATION: Total $ �a� <br /> 4 94:��Z <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: <br /> ❑Water ❑Sewer ❑Storm <br /> []Traffic Mitigation Eval <br /> Approved By: ` Date: q ,� []Site Work/Drainage(shovm/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> hospital,supportive housing) <br /> []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: VA 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 X 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: Date: °r Z -1- ❑ 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 Bye— Date: -? ?eZ <br />