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A-te <br /> Intake &Approval She (FOR PERMIT STAFF ONL)9 PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: ,n . <br /> Zone <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: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction ILLPlanning/Landscape Inspection Required before Final? ❑Yes []No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load T Q—(, School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ©No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 112021 E12018 ❑2015 []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$ (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: Np fV-vJ ell AOn 1ziC k �W5►wcc) <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes MNo Additional Notes: <br /> VALUATION CALCULATION: Total$_� if1d l <br /> pproved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PIN Review&Worksheet Needed if.' <br /> i❑Sys Dev Eva I: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> (Traffic Mitigation Eval <br /> Approved By: Date: []Site Work/Drainage(shown/triggered) <br /> I <br /> ❑Address Letter <br /> FIRE DEPARTMENT ElBackfiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: 1 <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: ❑ 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 B Date: Z(j�j <br />