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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <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 Require (Pre-Insp) Overlay/Agreement DonH0(j Corn . 1-5 <br /> Bldg/TI/Addn/Rem Size Nonresidential Use W amr <br /> Garage/Accessory Struct.Size Residential Use N <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 EINo <br /> Occupancy Group "In Lieu"Fee:Type: i Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No MWes ❑Shell Only Calculated: Credit: <br /> Code Year Zf2021 112018. 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System Wot 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 Not 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 EF No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ffNo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> ff� OG �Q/.I Approved By: Date: O 2oz <br /> L PUBLIC WORKS <br /> °� 660 <br /> •l„�s,D �,�r` Intake OK by: Date: <br /> Intake Comments: T J PW Review&Worksheet Needed if: <br /> []Sys Dev Eva[ <br /> Additional Notes: ,,,vµ I ❑Water ❑Sewer ❑Storm <br /> p p�5' E <br /> t]Traffic Mitigation Eva[ <br /> Approved By:e_l1,j Date: /Y'1 ![]Site Work/Drainage(shown/triggered) <br /> ElAddress Letter <br /> FIRE DEPARTMENT C]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: i <br /> Additional Notes: JKI�Thls Permit is Approved by Public Works <br /> LJ 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 /> 2'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: Date: 7 Q �`( . ❑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 /> ELECTRICAIJPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: , <br />