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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# � -WKS- <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: S ZG 'L <br /> Intake Comments: Intake Comments: <br /> Zone 2 <br /> ❑ Make this a"W"Permit ❑ SRC Required (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: 4.D <br /> Basement ENo ❑Yes , Fin/Unfin Total No. of Dwelling Units: <br /> Type of Construction � Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Occupancy Group Tpu— "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load L-IvL School Impact Fee: Total $ <br /> Cert. of Occpuancy Required?JUINo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 2021 ❑2018 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System—El Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System )DNot 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 priortofinal? ❑Yes ®No Additional Notes: SV(Vtl re vhr — <br /> VALUATION CALCULATION: Total$ / 40 S+W,4v2 111C-Vt-1Q-S <br /> Approved By:�- v/++ tom Date: �A.hq <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> E <br /> i❑Sys Dev Eval <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> I <br /> 3 <br /> j❑Traffic Mitigation Eva] <br /> Approved By: Date: r\ Zv\ ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT I <br /> 1❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: ;(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(join with this folderfor permit issuance) <br /> Approved By: Date: ❑ WIII 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: ��{�� /K All H SG1P� <br /> Approved By: Date: Completed By: Date: 15�11' ,12 <br />