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Intake &Approval Sheet JR PERMIT STAFF ON09 I cRMIT# V 1 1- <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: 6u Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> BldgM/Addn/Rem Size 4 a Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement IgNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction C, Planning/Landscape Inspection Required before Final? ❑Yes []No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load L School Impact Fee: Total $ <br /> Cert.of Occpuancy Required?I El No OYes []Shell Only Calculated: Credit: <br /> Code Year I❑2021 P2018 1:12015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: []Update Existing ❑New System DINot Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System El 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 dots required prior to final? ❑Yes ®No Additional Notes: <br /> iJNi°y <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: .,, ZK <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: IPWReview&Worksheet Needed if. <br /> • <br /> []Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: D []Site Work/Drainage(shown/triggered) <br /> Address Letter <br /> 3 <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> !hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: aThis Permit is Approved by Public Works <br /> 0,8ee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: V.A Separate PW Permit is Required(Permit#:PW Z-4o Z-o 3.3) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE RLls located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder[join with this foiderfor permit issuance) <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 -- _. Date: Z!7_4 ?47— <br />