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Intake & Approval Sheet (FOR PERMIT STAFF ONL1) PERMIT # i!) <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />'j-10Z <br />Garage/Accessory Struct. Size <br />0 <br />Number of Stories <br />' L <br />Basement <br />i&]No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />�e l <br />Cert. of Occpuancy Required? <br />❑No " Yes []Shell Only <br />Code Year 102021 <br />912018 1:12015 <br />Fire Sprinklers: ❑Update Existing ❑New System [PNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ©NotReq'd <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 15No <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />[]Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional No — <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />1 1 D­A. ... / < .-- - AM-1 CDC CCC <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />/ <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final. ®Yes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: v l% Cre t: <br />❑Everett School Dist Q�Iukilt School Dist <br />Park Impact Fees for permits appl' d for after 1/112022: <br />Park Impact Fee Total 5 / C V (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): LZ 3 <br />Additional Notes: <br />Approved By: �,'^ Date: //-/4/- 73 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: ( PW Review & Woiksheet Needed if. <br />I ❑Sys Dev Eval <br />❑Water ❑Sewer ❑Storm <br />[]Traffic Mitigation Eval <br />'[]Site Work/Drainage (shown/triggered) <br />I <br />❑Address Letter <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />This Permit is Approved by Public Works <br />191 <br />See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folderfor permit Issuance) <br />❑ 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 />Additional Notes: <br />Completed By: Date: (� f <br />f•� <br />