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Intake & Approval Sheet (FOR PERMIT STAFF ONVO PERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No Yes, Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />M <br />Occupancy Load <br />Cart. of Occpuancy Required? <br />1ONo ❑Yes ❑Shell Only <br />Code Year <br />1912021 ❑2018 112015 <br />Fire Sprinklers: El Update Existing ❑New System Mlot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'[ RCW 64.55 dots required prior to final? ❑Yes WNo <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: q Date: 1 <br />FIRE. DEPARTMENT. <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />rr❑ Minimal or No Fire Scope - NO FIRE FEE <br />L Review / Inspection Scope --ADD FIRE FEE <br />Approved By: Y,_Date: <br />'.ELECTRICAL/PLUMBING,: <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />L k 2- <br />Overlay/Agreement <br />IdeWCX\1- Anon <br />Nonresidential Use <br />S - <br />Residential Use <br />4 pi <br />Proposed No, of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes UJNO <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: 1Z Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: p <br />ON <br />PUBLIC WORKS <br />Intake OK by: Date:' <br />Intake Comments: PWRevfew&WorksheetNeeded if. <br />• +-- <br />❑Sys Dev Eval': <br />❑Water ❑Sewer ❑Storm <br />i OTraffic Mitigation Eval <br />❑Site Work/Drainage (shown/triggered) <br />(]Address Letter <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />❑ This' Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND '❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folder for permit issuance) <br />❑ 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 />Additional Notes: <br />Completed By: ,g/" ovkDate: -1 <br />u <br />k sub <br />c►rtg <br />