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Intake & Approval Sheet (FOR PERMIT STAFF ONLr PERMIT # 023 11 ' D23 <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 />IjINo ❑Yes , Fin / Unfin <br />Type of Construction <br />fit <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />1@No ❑Yes"❑Shell Only <br />Code Year <br />❑2021 92018 ❑2015 <br />Fire Sprinklers: ❑Update Existing ❑New System ®Not Peq'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ®No <br />VALUATION CALCULATION: Total $ �g66 <br />Additional Notes: <br />Approved By: Date: a <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 />❑ Minimal or No Fire Scope - NO FIRE FEE <br />IR(Review / Inspection Scope - ADD FIRE FEE <br />Approved By LV Date: ja <br />ELECTRICAL/PLUMBING. <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: QSS Date: i K32 S <br />Intake Commeffits: <br />Zone <br />wj <br />Overlay/Agreement <br />Nonresidential Use <br />OK 1 c.e S <br />Residential Use <br />pV <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes,�gNo <br />"In Lieu" Fee: Type: Amount $O <br />School Impact Fee: Total $ o <br />Calculated: Credit: <br />El Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />y 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: I2 <br />U <br />PUBLIC WORKS <br />Intake OK by: IQ) 1 U7. <br />Intake Comments: PW Review & Worksheet Needed if.* <br />®❑Sys Dev Eval <br />❑Water []Sewer ❑Storm <br />❑Traffic Mitigation Eva] <br />[]Site Work/Drainage (shown/triggered) <br />tab <br />!. E❑Address Letter <br />` <br />at I A" � I❑Backflow Prevention for high hazard: <br />41,wiwiw y) (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 folderfor permit issuance) <br />❑ WIII 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 jAAkAjVAyjpt&j Date: It <br />12612N-5 <br />