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� avi si 0 nj Q-Hf r a Wd .4- <br /> Intake & Approval Sheet (FOR PERMIT STAFF ON09 PERMIT# fi 230 U3A__ <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Jess Date: 13 2 <br /> Intake Comments: Intake Comments: <br /> Zone -1 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size )14 Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use AF VA <br /> Number of Stories Proposed No.of Dwelling Units: --- <br /> Basement SNo ❑Yes , Fin/Unfin Total No.of Dwelling Units: l <br /> Type of Construction I 91L Planning/Landscape Inspection Required before Final? ❑Yes BNo <br /> Occupancy Group Af-R "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load 5'-N L School Impact Fee: Total $© <br /> Cert. of Occpuancy Required? ❑No IRYeS ❑Shell Only Calculated: Credit: <br /> Code Year 1112021 2018 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System ®Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 0-(net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing I]New System Eallot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Ye No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes E�_No Additional Notes: <br /> VALUATION CALCULATION: Total$ 4;0,000f <br /> Approved By: Date:5 15 2H <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed If., <br /> ❑Sys Dev Eva[: <br /> ❑Water ❑Sewer ❑Storm <br /> Additional Notes: <br /> �trC -U{�5 ❑Traffic Mitigation Eval <br /> i <br /> Approved By: Date:9 4 Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Se <br /> p q hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: <br /> ❑ This Permit is Approved b <br /> Additional Notes: pp Y Public Works <br /> 4 ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit M 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: 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: Completed By Date: P <br />