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Intake & Approval Sheet t#-OR PERMIT STAFF ONL ERMIT#�G �- 0c;l <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 7 Z)f 97 bL�e Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement ❑No MYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction -�e L Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Occupancy Group -71Z "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load W L School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No Yes []Shell Only Calculated: Credit: <br /> Code Year 1-12021 M2018 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 /> Reason Sprinklers Required: Park Impact Fee Total$ j (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing ❑New System ®Not 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 21No Additional Notes: <br /> VALUATION CALCULATION: Total$, O/ 9 <br /> Approved By: Date: f Z !� ZOL <br /> PUBLIC WORKS <br /> Intake OK by: Date:__ <br /> Intake Comments: JPW Review&Worksheet Needed if: <br /> []Sys Dev Eval <br /> l <br /> Additional Notes: (4p _ w`rtlx W`041> I ❑Water ❑Sewer ❑Storm <br /> I❑Traffic Mitigation Eval <br /> Approved By: Date: p []Site Work/Drainage(shown/triggered) <br /> ¢i ❑Address Letter <br /> 3 <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> j(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: 1hospital,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 /> 'f9-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 folderfor permit issuance) <br /> Approved By: r Date: —12-2 ❑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: - 262 <br />