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Intake & Approval Sheet (FOR PERMIT STAFF ONL19 PERMIT# �Z3 Z 66 <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 W!1(9 Nonresidential Use <br /> Garage/Accessory Struct.Size 3 Residential Use V <br /> Number of Stories Proposed No. of Dwelling Units: <br /> Basement ®No ❑Yes, Fin/Unfin Total No.of Dwelling Units: / <br /> Type of Construction r U Planning/Landscape Inspection Required before Final? QYes ❑No <br /> Occupancy Group Ir RL_G "In Lieu"Fee:Type: — Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? []No ®Yes []Shell Only �Calculated: 6 1 Z6, — Credit: 49` <br /> Code Year ❑2021 �2018 ❑2015 sl dEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: []Update Existing []New System ©Not Req'd Park Impact Fees for permits pplied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 3 !(net due after credit for existing uses <br /> Fire Alarm: El Update Existing ❑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 'Q No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total$ �L ki , fl,C <br /> Approved By: Date: <br /> l �8 klb <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> � p Intake Comments: j _----- <br /> '. <br /> PW Review&Worksheet Needed if., <br /> ' '❑Sys Dev Eval: <br /> Additional Notes: []Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date: ❑Site Work/Drainage(shown/triggered) <br /> f <br /> ❑Address Letter <br /> f <br /> FIRE DEPARTMENT !(dental, <br /> ❑B medical,animals,mortuary, <br /> Prevention for high hazard: <br /> Separate/Deferred Submittals Required: !hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm []Other: i <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 foiderfor permit issuance) <br /> Approved By: V 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: 7 777 Date: <br />