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Intake & Approval Sheet --OR .HERMIT STAFF ONLY) ERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit <br />❑ 5RC Required (Pre-Insp) <br />Bldg/Tl/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />FIND ❑Yes , Fin / Unfin <br />Type of Construction <br />d <br />Occupancy Group <br />Occupancy Load <br />Cart. of Occppancy Required? <br />oNo CIYes []Shell Only <br />Code Year [12021 2018 02015 <br />Fire Sprinklers: OUpdate Existing ONew System IgNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: Update Existing []New System IKNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for peri-div ElYes ® No <br />Add'[ RCW. 64.55 does required prior to final? ElYes KJNo <br />VALUATION CALCULATION: Total $ IDS <br />Additional Notes: <br />Approved By: CQ Date: 'S <br />FIRE DEPAPTIVINY <br />Separate I Deferred Submittals Required: <br />Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />El Review of As -Built Plans - NO FIRE FEE <br />L1 Minimal or No Fire Scope - NO FIRE FEE <br />IM Review/inspection Scope - ADD FIRE FEE <br />Approved By: o Date:�j -� <br />E1..Ei✓TRICALIPLUMBING <br />Additional Notes: <br />Approved By: Date, <br />PLANNING <br />Intake OK by- Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Netac <br />Nonresidential Use <br />A Mi d Ism Cd <br />Residential Use <br />Nth <br />Proposed No, of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planningll.andscape Inspection Required before Final? QYes MNo <br />"In Lieu" Fee: Type: tAfft Amount $ <br />School impact Fee: Total $ A <br />Calculated: N(h Credit: N f h <br />QEverett School Dist ElMukilteo School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park Impact Fee Total (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): _ N <br />Additional Notes: N j (� <br />Approved By: Date: 02 202_ <br />WA <br />' PURLIC 1N014K8 <br />Intake OK by: Date: <br />.. . ................,,,,,•..,.,.,.,..,,,,,...................,,.,, <br />Intake Comments: pWRevlaw & WorksheetNeeded if- <br />f USys Dev Eval : <br />!! []Water LISewer ❑Storm <br />t[]Traffic Mitigation Eval <br />E031te Work/Drainage (shown/triggered) <br />!OAddrass Letter <br />ElBackilow Prevention for high hazard: <br />`(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />E <br />El 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 />11 Is located in this folder <br />Q Is in a Separate Green Foldergornwiththis foiderforpermltIssuance) <br />a Will be issued separately (Separate Green Folder, PW issued ahead ofl3ldg) <br />,Public Works has. no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed 13 . <br />Date: 2� <br />Ir e.A <br />