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C � <br /> 4 �M � )­6n ikwo 7�— - 1-� <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# / 8 O <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:% / Date: 2 <br /> Intake Comments: Intake Comments: <br /> Zone -7— <br /> El Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> B1dg/TI1Addn/Rem Size M a 04 Nonresidential Use <br /> Garage/Accessory Struct. l e Residential Use <br /> Number of Stories 1 Proposed No.of Dwelling Units: <br /> Basement BNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction �, Planning/Landscape Inspection Required before Final? ❑Yes ONO <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load} School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? 51No ❑yes ❑Shell Only Calculated: Credit: <br /> Code Year 112021 912018. 1:12015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System IRNot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El New System QNot Req'd Fee Schedule Used For Calculation(Year): <br /> _-._...------- <br /> ._ <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 pdorto final? ❑Yes QNo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> �(p Approved By. Date: :F v.�/Z.y <br /> 4 PUBLIC WORKS <br /> Intake OK by: Date: _ <br /> Intake Comments: PW Review&Worksheet Needed if.— <br /> ❑Sys Dev Eva[ <br /> Additional Notes: <br /> j ❑Water ❑Sewer ❑Storm <br /> E <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 /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: <br /> ;hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#:PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> LN 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: 6 JWK <br />