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Intake &Approval Sheet )R PERMIT STAFF ONLIq .MIT# <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 (moo <br /> Bidg/TI/Addn/Rem Size t-11A Nonresidential Use <br /> Garage/Accessory Struct-Size Residential Use �< <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement RNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Occupancy Group lv�L. "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 1112021 V2018 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New system QNot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System NNot Req'd Fee Schedule Used For Calculation(Year): <br /> ,,__,..,.............. <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No <br /> Add]RCW 64.55 dots required prior to final? ❑Yes EONo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: f Date: /2 z <br /> PUBLIC WORK5 <br /> Intake OK by: Date: Z,_1q 172, _ <br /> Intake Comments: PW Review&Worksheet Needed if._ <br /> Additional Notes: �Y$� cM ►VIs�I S ❑Water ❑Sewer ❑Storm <br /> a-plk &4A 1171Traffic Mitigation Eva[ <br /> Approved By: !,l Date: Z !I]Site Work/Drainage(shown/triggered) <br /> i <br /> {(]Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> !hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: t <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 Goin with this foiderforpem,itissuance) <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: <br />