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Intake & Approval Sheet (t-OR PERMIT STAFF ONLY) PERMIT#b 2t�o1 <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 J Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No RfYes, Fin nfi _ Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? Dyes ❑No <br /> Occupancy Group QZ E "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load (Z-C School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? No jj�es ❑Shell Only Calculated: Credit: <br /> Code Year 112021 M2018 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System NgNot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (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: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ®No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes [ANo Additional NZ�_ <br /> VALUATION CALCULATION: TotaI$ L'0(� —i L 2 <br /> Approved By: Date: <br /> Q Jl.0 tr(t 0 1,J PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: I PW Review&Worksheet Needed if: <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eva[ <br /> Approved By D te: I II❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate!Deferred Submittals Required: i(dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> 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 folderfor permit issuance) <br /> Approved By: Date: ❑Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> ublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAUPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: 2p Z <br />