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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT 5a"7 - <br /> 13UILDING <br /> PLANNINGIntake OK by: Date; Intake OK by: Assign To: Di' � <br /> intake Comments: Intake Comments: <br /> Zone <br /> Meka this a"W"Permit ❑SRC Required (Pre•lnop) Overlay/Agreement <br /> 13ldgITllAddn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size kA� Residential Use <br /> Number of Stories 1 Proposed No.of Dwelling Units: <br /> Basement END ElYes, Fin I Unfiri Total No.of Dwelling Units: <br /> Typo of Construction PlanninglLandscape Inspection Required before Final? C(Yes []No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cent.of Ocepuancy Required? CINo 4Yes }]Shell Only Calculated: Credit: <br /> Code Year JU2021 102018 E12015 QEverett School Dist E lMukilteo School Dist <br /> Fire Sprinklers: Update Existing UNew system Not Req'd Park Impact Pees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for exisift uses) <br /> Fire Alarm: El Update Existing El New System E4Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheetrsq'd for permit? BYes CI No <br /> Add'I RCW 64.55 dots required prior to final? ElYes DjNo Additional Notes: <br /> VA:UA7f0N CALCULATION: Total$_ 5"O .a <br /> Approved By: Date: <br /> � 9r��1 <br /> PUIB.LiC WORKS <br /> 1 �� 5118 Intake OK by: Date: <br /> V �` Intake Comments: jpWR ; Y rks.hee,mN..e,..e�d�e�d�i.fYL .,.�...w, <br /> A EISys Dev Eval: <br /> I ❑Water []Sewer []Storm <br /> Additional Notes: <br /> fLITraffic Mitigation EvaI, <br /> l <br /> Approvedl3y: (_ �. Date; ' []Site WorklDrainage(shownitrrggered) <br /> f[]Address Letter <br /> T Ili'DEPARTM; 1013acktlow Prevention for high hazard: <br /> Separate Deferred Subrnittals Required: '(dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> Fire Sprinklers Fire Alarm DOther: <br /> Additional Notes: his Permit Is Approved by Public Works <br /> n See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: Separate PW Permit is Required(Permit#:PW Z'O2 •O 3)3 <br /> Review of As-Built Plans-NO FIRE FEE AND ❑Is fully digital A` � S 5 rtfl <br /> inimal 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 fforn With thrsfolderforpermItIssuance) <br /> Approved By: ate; El Will be issued Separately(Separate Green Folder,PW issued ahead of9ldg) <br /> Public Works has-no scope on this permit--PW Not Required <br /> E,LE0 fRICALIPLUMBING Additional Notes: <br /> [Approved <br /> dditional Notes: ` <br /> By: Date, Completed By. Date: 4 I(Q 4z_ <br />