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Intake &Approval Sheet (FOR PERMIT STAFF ONLIO PERMIT# <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/Adds/Rem Size W&O _b(ilf. Qo9 AwAid-k Nonresidential Use <br /> Garage/ cessory Struct.Size Z —la t% Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement ❑No NYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction (, Planning/Landscape Inspection Required before Final? Dyes ❑No <br /> Occupancy Group IIZL "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 'L School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? El No ®Yes ❑Shell Only Calculated: Credit: <br /> Code Year 112021 EQ2018 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System ®Not 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 /> ROW 64.55 MF worksheet req'd for permit? ❑Yes En Ei No <br /> Add]RCW 64.55 docs required prior to final? ❑Yes LJNo Additional otes: <br /> VALUATION CALCULATION: Total <br /> ,4 'd 9 6 S-hE <br /> Apf3roved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if.� <br /> ❑Sys Dev Eva[ <br /> -�/_ w5 ❑Water ❑Sewer ❑Storm <br /> Additional Notes: �)�„�' vt,.� <br /> ❑Traffic Mitigation Eva[ <br /> Approved By: Date: 7> D y ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ;❑Backflow Prevention for high hazard: <br /> ;(dental,medical,animals <br /> Separate/Deferred Submittals Required: mortuary, <br /> ;hospital,supportive housing) <br /> ❑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 folder for permit issuance) <br /> Approved By: n Date: C7_. G ❑ 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: Date: Z <br />