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Intake &Approval Sheet (FOR PERMIT STAFF ON09 PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: P-S5 Date: i ? 2 <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement M/A <br /> Bldg/TI/Addn/Rem Size Nonresidential Use fv/A <br /> Garage/Accessory Struct.Size Residential Use S F R <br /> Number of Stories Proposed No.of Dwelling Units: NIA <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: 1 <br /> Type of Construction 2L Planning/Landscape Inspection Required before Final? ❑Yes ®No <br /> Occupancy Group "In Lieu" Fee:Type: Amount$0 <br /> Occupancy Load 'r School Impact Fee: Total $ O <br /> Cert.of Occpuancy Required? &QNo Yes []Shell Only Calculated: Credit: <br /> Code Year 112021 R2018 112015 []Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System LYNot 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 QNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: �' - <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No <br /> Add']RCW 64.55 does required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ a4 i b <br /> Approved By: Date:7 Zc{ ZN <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: IPW Review&Worksheet Needed if: <br /> i I-]Sys Dev Eval <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> 3 <br /> I❑Traffic Mitigation Eval <br /> Approved By: Date: 'J ( €❑Site Work/Drainage(shown/triggered) <br /> []Address Letter <br /> i <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <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[join with this foiderfor permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 10 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: A4to 1 Z <br />