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Intake $ Approval Sheet (FOR PERMIT STAFF ONLI) PERMIT# Z30? 03 9' <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 Requi ed(Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement No []Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group /—I "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load jr- '/S School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No 25Yes ❑Shell Only Calculated: Credit: <br /> Code Year 102021 R2018 1:12015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing []New System 0Not 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: El Update Existing ❑New System MNot 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'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $ <br /> A proved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: f19 Date: 0 qb CJ2 <br /> Intake Comments: PW Review&Worksheet Needed If., <br /> []Sys Dev Eva I: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: Date:;6i <br /> (�(�✓ ❑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: <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 Qoin with this folder for permit issuance) <br /> Approved By: Date: ❑ WIII be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> Public Works as no scope on this permit--- PW Not Req ire <br /> ELECTRICAL/PLUMBING Additional NotesqAm". *0y146Xy 1/111-0 Vaw; <br /> Additional Notes: QQ (1p 0 )i <br /> Approved By: Date: Complet d By: Date: <br />