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Intake & Approval Sheet (FOR PERMIT STAFF ONL PERMIT#_ AQt U5(Q <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:�l� Date: 2' M U <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg[TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct. Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement E]No UYes , Fin/Unfin Total No. of Dwelling Units: <br /> Type of Construction 1 Planning/Landscape Inspection Required before Final? ❑Yes WNo <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load yy School Impact Fee: Total $ P (^ <br /> Cert.of Occpuancy Required? []No Yes ©Shell Only Calculated: Credit: <br /> Code Year ❑2021 ❑2018 112015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing El New System ONot Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ O f� (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 © No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IgNo Additional Notes: <br /> VALUATION CALCULATION: Total $ �l�k ,44 <br /> Approved By: Date: M <br /> PUBLIC WORKS <br /> Intake OK by: Wr, Date: 116 <br /> Intake Comments: PW Review&Worksheet Needed if: _ <br /> SQN� <br /> �,,,.i,d �f �MSys Dev Eval <br /> Additional Notes: r r �1114 �w �I �I� ❑Water ❑Sewer OStorm <br /> ❑Traffic Mitigation Eval <br /> A roved B <br /> Pp y: Date: �� L Site Work/Drainage(shown/triggered) <br /> �(�' IiVT QAddress Letter <br /> � V t <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> !(dental,medical,animals, mortuary, <br /> Separate/Deferred Submittals Required: ihospital,supportive housing) <br /> ❑Fire Sprinklers 517ireAlarrn []Other: <br /> Additional Notes: 4&This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: VLA Separate PW Permit is Required (Permit#: PW24<>5-C 33 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 59-IS located in this folder «-V•l t'lrtl B 2404. OSS <br /> eview/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(Join with this folder for permit issuance) <br /> Approved By: ` Date: ,50-',V_Z ❑ 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 B Date: <br /> G it 2.t <br />