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Intake $ Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT## V W3_ <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: _ Date: e4zL) <br /> Intake Comments: Intake Comments: <br /> Zone H r <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement A l A + Ar GP► <br /> B1dg/TI/Addn/Rem Size Nonresidential Use N► h TIN AVS-hriml <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No,of Dwelling Units: <br /> Basement mNo' []Yes, Fin/Unfin Total No,of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes &No <br /> Occupancy Group "A "In Lieu"Fee:Type: Amount$ CD <br /> Occupancy Load School Impact Fee: Total $ D <br /> Cert.of Occpuancy Required? E�No ❑Yes []Shell Only Calculated: Credit: <br /> Code Year Q2021 ❑2018. ❑2015 []Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System QNot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ Q (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System IgNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: --•----- ___v_.-__ _ <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EQNo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: 8 6 Z 4 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed ik <br /> rl�Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: \VNDate: []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: ❑ 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 writh this folderfor permit Issuance) <br /> Approved By: 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: lCompleted By: .Date: 01 <br />