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Intake &Approval Sheet (i 2 PERMIT STAFF ONLY) P AIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Commen : intake Comments: <br /> Zone <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-insp) Overlay/Agreement At A } A C)4 <br /> Bldg/TI/Addn/Rem Size g6-27 Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use — <br /> Number of Stories v Proposed No.of Dwelling Units: <br /> Basement WNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: — <br /> Type of Construction Planning/Landscape Inspection Required before Final? ❑Yes ®No <br /> Occupancy Group i "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ ' <br /> Cert.of Occpuancy Required? ❑No XYes ❑Shell Only Calculated: Credit: <br /> Code Year 112021 j9Q18 ❑2015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: V[Tpdate Existing I---lNew system ❑Nat 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: PlIipdate Existing ❑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 5U-No <br /> Addl RCW.64.55 does required prior to final? ❑Yes 1,gNo Additional Notes: <br /> VALUATION CALCULATION: Total <br /> Approved By: Date:ZA/Zy <br /> PUB.LIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PYYReview&Worksheet Needed if.•YY1 MY <br /> QSys Dev Eva[: <br /> II ❑Water ❑Sewer QStorm <br /> Additional Note . <br /> l <br /> i IQTraffic Mitigation Eval <br /> Approved By: Date: lQSite Work/Drainage(shown/triggered) <br /> f)]Address Letter <br /> FikE DEPARTMENT jQBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: i(dental,medical,animals,mortuary, <br /> Ihospital,supportive housing) <br /> dire Sprinklers 151Fire Alarm ❑Other: ; <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:K A ( K Date: ZO Z� ❑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 /> ELECTRICALIPLUMBING Additional Notes: <br /> Additional Notes: ` <br /> Approved By: Date: Completed 3 . �� Date: calo r6z4- <br />