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Intake &Approval Sheet (I- PERMIT STAFF ONLY) Pi- n1T# f1:2 Y —D ?(�
<br /> BUILDING PLANNING
<br /> intake OK by: - Date: ' "� Intake OK by: Assign To:_Je,-,,,,s Date: Z _ I`Zf
<br /> Intake Comments: Intake Comments:
<br /> Zone L.L 2
<br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement A 1 A 1- ACA
<br /> Bldg1Tl/Addn/Rem Size z. Nonresidential Use S ch o015
<br /> Garage/Accessory Struct.Size Residential Use —
<br /> Number of Stories — Proposed No.of Dwelling Units:
<br /> Basement FTNo ❑Yes, Fin/Unfin Total No.of Dwelling Units:
<br /> Type of Construction PlanninglLandscape Inspection Required before Final? []Yes ISNo
<br /> Occupancy Group l "in Lieu"Fee:Type: Amount$(�
<br /> Occupancy Load /l-% 7 l% School impact Fee: Total $ O
<br /> Cert.of Occpuancy Required? NNO ❑Yes ❑Shell Only Calculated: Credit:
<br /> Code Year 1112021 18 02015 ❑Everett School Dist ❑Mukilteo School Dist
<br /> Fire Sprinklers: pdate 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: P�pdate Existing❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year):
<br /> ReasonFire Alarm Required: ..•.__.._,._.,..,,,__..m.,_._.__�,.,__..,._....__,__.,,,._w..,w___MM,,,....,.,,_.�.._....._.,....,.,_..._.,,.,,..__.,..,,_._.,.,,
<br /> RCW 64.55 MF worksheet req'd for perrriiV ❑Yes No
<br /> Add'i RCW 64.55 docs required prior to final% ❑Yes ONo Additional Notes:
<br /> VALUATION CALCULATION: Total! a f`- I
<br /> �`- Approved Sy: Date: 2/fo ZH
<br /> PUBLIC WORKS
<br /> Intake OK by: Date:
<br /> ......... .
<br /> Intake Comments: PWReview&Worksheet Needed if,
<br /> QSys Dev Eva[:
<br /> Additional Notes:
<br /> Q I Water ❑Sewer QStorm
<br /> QTraffic Mitigation Eval
<br /> S
<br /> Approved By: ate: 2QSite WorklDrainage(shown/triggered)
<br /> IV Vt
<br /> i❑AddresS Letter
<br /> FIRE DEPARTMENT �QBacdow Prevention for high hazard:
<br /> !hospital,
<br /> (dental,medical,animals,mortuary,
<br /> Separate 1 Deferred Submittals Required: supportive housing)
<br /> Fire Sprinklers .Fire Alarm ❑Other:
<br /> 4
<br /> Additional Notes: ❑This Permit is Approved by Public Works
<br /> ❑See PW Review Worksheet and associated attached items
<br /> Fire Dept.Fees: ❑ASeparate 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 Goin with this folder for permit issuance)
<br /> Approved By: , Date: Will be issued separately(Separate Green Folder,PW issued ahead of Bldg)
<br /> X-Public Works has.no scope on this permit---PW Not Required
<br /> ELECTRICALiI?LUMBING Additional Notes:
<br /> Additional Notes: `
<br /> Approved By: Date: Completed 13y: Date: pZ o3 tv Z
<br />
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