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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#_ "3c) <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: 1>6% Date: q 04k 2-013 <br /> Intake Comments: Intake Comments: <br /> Zone fA V <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement M�}ir0 <br /> Bldg/TI/Addn/Rem Size A& Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement 6QNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction A& Planning/Landscape Inspection Required before Final? ❑Yes IMNo <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ PJ A <br /> Occupancy Load I School Impact Fee: Total $ PIA <br /> Cert.of Occpuancy Required? KNo ❑Yes []Shell Only Calculated: Credit: <br /> Code Year 02021 R12018 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: [-]Update Existing ❑New System QNot Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: ry1'' Park Impact Fee Total$ *J 6A (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El System 1Q Not Req'd Fee Schedule Used For Calculation(Year): <br /> —---------------_-..r..______ <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Q No <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes QNo Additional Notes: <br /> VALUATION CALCULATION: Total$ y 69 ,lN <br /> Approved By: Date: Oa 2otib <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: ;PReview_8-W_orksh__eet Needed if:��- <br /> f❑Sys Dev Eval: <br /> Additional Notes: L ZCI t— e J Q �u►�t�1n, i ❑Water ❑Sewer ❑Storm <br /> y r J I DTraffic Mitigation Eval <br /> Approved By: Date:J'j) ;t 7 ❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> lhospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: j <br /> Additional Notes: 1P 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 /> r <br /> Review/Inspection Scope-ADD FIRE FEE ❑ is in a Separate Green Folder Coin with this folderfor permit issuance) <br /> roved By: Date: 3 ❑ 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: / / r f� <br /> Additional Notes: 11C4jr' �6 t-�`i hL'r✓ �i� �/,l J Tor 4 <br /> Approved By: Date: Completed By: Date: Z <br /> Owl <br />