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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT #_ ��� <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />6QNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />YA <br />Occupancy Load <br />IW <br />Cert. of Occpuancy Required? <br />KNo ❑Yes []Shell Only <br />Code Year <br />02021 R12018 ❑2015 <br />Fire Sprinklers: [-]Update Existing ❑New System QNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing ❑New System EKIJVot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes Q No <br />Add'I RCW 64.55 dots required prior to final? ❑Yes EINo <br />VALUATION CALCULATION: Total $ y 69 ,iN <br />Additional Notes: L ZCI_ �� rN J <br />Approved By: <br />Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />r <br />Review / Inspection Scope - ADD FIRE FEE <br />roved By: Date: 3 <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: 1>6% Date: q 04k 2-011 S <br />Intake Comments: <br />Zone <br />fA V <br />Overlay/Agreement <br />vActyb <br />Nonresidential Use <br />it% j I cny <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes IMNo <br />"In Lieu" Fee: Type: Amount $ P l A <br />School Impact Fee: Total $ PIA <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ *J 6A (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: Otk 2otib <br />k— <br />PUBLIC WORKS <br />Intake OK by: <br />Date: <br />Intake Comments: <br />; PReview _ 8-W_orksh__eet Needed if. ��- <br />I <br />f []Sys Dev Eval : <br />❑Water ❑Sewer []Storm <br />[]Traffic Mitigation Eval <br />❑Site Work/Drainage (shown/triggered) <br />❑Address Letter <br />[]Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />I <br />hospital, supportive housing) <br />This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ is located in this folder <br />❑ Is in a Separate Green Folder Coin with this folderfor permit issuance) <br />❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: Date: <br />Z <br />