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Intake &Approval Sheet 'OR PERMIT STAFF ONLY =RMIT# <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 <br /> Bldg/TI/Addn/Rem Size Nonresidential Use ( Q <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 PlanninglLandscape Inspection Required before Final? ❑Yes []No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? Qlo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 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 /> i <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing ON.,System EINct Req'd Fee Schedule Used For Calculation(Year): <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 ! b J)z10 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> OSys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ]]Traffic Mitigation Eva[ <br /> Approved By: Date: �LA E[]Site Work/Drainage(shown/triggered) <br /> Address Letter <br /> FIRE DEPARTMENT f I313ackfiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: I(dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> El 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 gain with this folder for permit issuance) <br /> Approved By: Date: _ 10 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Zditional Notes: <br /> Additional Notes: ` <br /> Approved B Date: Com Ieted B Date: <br /> PP Y� P Y- 7i <br />