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Intake &Approval Sheet OR PERMIT STAFF ONLY] <br /> BUILDING <br /> Intake oPLANNING <br /> 7y-. _ Date: <br /> Intake C Intake OK by; Assign 70:_ ,�,Y�= Date: <br /> Intake Comments: <br /> Zone P❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement N�n B Idg/Tl1Ad dr*—R-e—m--TLz-e—j Q33 <br /> Nonresidential Use <br /> Garage/Accessory Struct.Size tV Number of Stories � Residential Use `- <br /> Proposed No.of Dwelling Units: _ <br /> Basement KIo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction <br /> Planning/Landscape Inspection Required before Final? ❑Yes IDNo <br /> Occupancy Group I'/ "In Lieu"Fee:Type: (Z <br /> Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? []No ❑Yes ❑Shell Only Calculated: (� <br /> Credit__ Q� <br /> Code Year 11112021 5N18 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing❑New System Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total <br /> (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing New System Not Req'd Fee Schedule Used For Calculation(Year): y ' <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 No Additional Notes: <br /> VALUATION CALCULATION: Total$ (,,s,&0 %" <br /> Approved By: Date: Zoe <br /> PUBLIC 11VORK5 <br /> Intake OK by: Date: <br /> Intake Comments: PWReview&Worksheet Needed if: <br /> []Sys Dev Eva[: <br /> Additional Notes: r ❑Water []Sewer ❑Storm <br /> l]Traffic Mitigation Eval <br /> Approved B • <br /> Pp Y• Date: I0Site Work/Drainage(shown/triggered) <br /> l <br /> Address Letter <br /> FIRE DEPARTMENT �(]BackfiowPreventionforhighhazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> I hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: i <br /> f <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 /> Public Works has,no scope on this permit---PW Not Required <br /> ELECTRICALIPLUMBING Additional Notes: <br /> [Approved <br /> dditional Notes: <br /> By: pate: Completed By: (14A Date: <br />