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Intake & Approval Sheet ;(FOR PERMIT STAFF ONLY) ;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 />ev 19'000 <br />Garage/Accessory Struct. Size <br />kOr� <br />Number of Stories <br />Q <br />Basement <br />Z`No ❑Yes , Fin / Unfin <br />Type of Construction <br />1 � 3 <br />Occupancy Group <br />S <br />Occupancy Load <br />.c9G A.)9) <br />Cert. of Occpuancy Required? <br />gNo ❑Yes []She[] Only <br />Code Year <br />02021 R2018 112015 <br />Fire Sprinklers: 54Update Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: 7kIA- <br />Fire Alarm: Nplpdate Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: �Y 0� <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ffNo <br />Add1 RCW. 64.55 does required prior to final? ❑Yes JgNo <br />VALUATION CALCULATION: Total $ <br />Additional Notes: ' <br />Approved By: Date: <br />vZ� (_% !/ I/ <br />FIRE DEOARTME[VT* <br />Separate / Deferred Submittals Required: <br />❑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 />Review/ Inspection Scope -ADD FIRE FEE <br />Approved By: , 'Date: L520--2--el <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: 1)L1 Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No, of Dwelling Units: <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes CgNo <br />"In Lieu" Fee: Type: Amount $ NIA <br />School Impact Fee: Total $ I A <br />Calculated: Credit: . <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park Impact Fee Total $ t1 I (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By. Date: 4 p'eb <br />PUBLIC WORKS <br />Intake OK by: Date: <br />-.,.,,..W,,,...... ... ... .,,•,,,,,,,,,,,-............ <br />Intake Comments: PW Review & Worksheet Needed if.• <br />[]Sys Dev Eva[ : <br />❑Water ❑Sewer ❑Storm <br />V10 of' v []Traffic Mitigation Eval <br />OSite Work/Drainage (shown/triggered) <br />�l]Address Letter <br />I OBacktlow 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 />❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />h/_1, Public Works has. no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: Date: <br />G , <br />X <br />