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t Q Vi S-i 0 n A�+lV 1ssIAJ� + . <br /> 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 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 FRNo ❑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$ <br /> Occupancy Load _ School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? �ffNo ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year ❑2021 WW18. 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:pupdate 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 El New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes qNo <br /> Add']RCW 64.55 docs required prior to final? ❑Yes Olo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By- Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PWReview d Worksheet Needed if., <br /> j❑Sys Dev Eval <br /> Additional Not <br /> ❑Water ❑Sewer ❑Storm <br /> OTraffic Mitigation Eva[ <br /> Approved By: ate: 1 OSite Work/Drainage(shown/triggered) <br /> 1'I]Address Letter <br /> FIRE DEPARTMENT 1 I]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: <br /> 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 with this folder for 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: lCompleted By: Date: <br />