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Intake &Approval Sheet (FOR PERMIT STAFF ONL PERMIT# 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: (O Nav <br /> Intake Comments: Intake Comments: <br /> Zone 'L <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement Aix <br /> Bldg/TI/Addn/Rem Size ( 6j Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories 7i • Proposed No.of Dwelling Units: <br /> Basement ❑No Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction nLf= Planning/Landscape Inspect" n Required before Fin ? Yes No <br /> Occupancy Group 2k= "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total Z$ <br /> Cert.of Occpuancy Required? ❑No ,Yes ❑Shell Only Calculated: L Z$L Credit: <br /> Code Year 02021 M018 ❑2015 Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System of Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ S,1000 (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing El New System PNot Req'd Fee Schedule Used For Calculation(Year): <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 MNo Additional Notes: <br /> VALUATION CALCULATION: Total <br /> L Approved By. • W. Date: 6 Jay, 20Z• <br /> 138 <br /> PUBLIC WORKS <br /> r Q� Intake OK by: Date: <br /> o <br /> j OL4 �1 0O Intake Comments: PWReview&Worksheet Needed if. <br /> ❑Sys Dev Eval <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eva[ <br /> Approved By: Date: []Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT �`❑Backflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: Ihospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: j <br /> Additional Notes: his Permit is Approved by Public Works <br /> IV See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 1A Separate PW Permit is Required(Permit#: PW2_402-'OS+ ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> Minimal or No Fire Scope-NO FIRE FEE W-Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: Date: 3 ❑ 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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: f47ctr7<- <br />