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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# C <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: 'D(A Date: 4 Oct- 2013 <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 0 -6�. Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use SF0. <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement o ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ®No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ Q I A <br /> Occupancy Load School Impact Fee: Total $ N(k <br /> Cert.of Occpuancy Required? o ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 102021 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 /> Reason Sprinklers Required: Park Impact Fee Total$ rilA (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System Mot 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'I RCW 64.55 docs required prior to final? ❑Yes &[No Additional Notes: <br /> VALUATION CALCULATION: Total$ r vG U <br /> Approved By: Date: 4 Doc U11 <br /> PUBLIC WORKS <br /> Intake OK by: Date: _ <br /> Intake Comments: PWReview&�WorksheetNeededif. - <br /> ❑Sys Dev Eva[ <br /> Additional Notes: P Yp�, r3 ihSN t� j ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eva] <br /> Approved By: Date: OSite Work/Drainage(shown/triggered) <br /> I <br /> I❑Address Letter <br /> FIRE DEPARTMENT E0Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: ;(dental,medical,animals,mortuary, <br /> =hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: I <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 Coin mah this folder for 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: <br /> Approved By: Date: Completed By: L Date: ( - <br />