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Intake &Approval Sheet (FOR PERMIT STAFF ONLY9 PERMIT# 0_6�5 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: PlQ Date: 1 40 <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑SRC Required(Pre4nsp) Overlay/Agreement K tR <br /> Bldg/TI/Addn/Rem Size UI � Sr • Nonresidential Use <br /> Garage/Accessory Struct.Size r Residential Use S <br /> Number of Stories 1— Proposed No.of Dwelling Units: <br /> Basement No WYes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? 1AYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ L W <br /> Cert.of Occpuancy Required? ❑No MYes []Shell Only Calculated: �.Z�6 Credit: <br /> Code Year ❑2021 IS2018 ❑2015 verett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: []Update 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 19 No <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes 91No Additional Notes: <br /> VALUATION CALCULATION: Total$ C— D i _ <br /> Approved By: Date: <br /> V PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: !PWReview&Worksheet Needed if.• <br /> f[]Sys Dev Eval <br /> �inA� ❑Water [:]Sewer ❑Storm <br /> Additional Notes: W' i <br /> I❑Traffic Mitigation Eval <br /> Approved By: Date: y []Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> I <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Ihospital,supportive housing) <br /> []Fire Sprinklers ❑Fire Alarm ❑Other: j <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 9A Separate PW Permit is Required(Permit#:PW2467 9-Up ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> Minimal or No Fire Scope-NO FIRE FEE GIs located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Goin with this foiderfor permit issuance) <br /> Approved By:A— 1 -. Date: ❑ Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> -f d wn ❑ Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: -7I ?.I <br />