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Intake&Approval Sheet itirR PERtiMl1'T STAFF ONLY) PERMIT# ot-tD3 _ (Lib <br /> BUILDING PL NG <br /> Intake OK by: Data: Intake OK by: Assign To: Date: <br /> intake Comments: intake Comments: <br /> Zone <br /> ❑Make this a"W"Permit ❑SRC Required(Pra•Inp) Overlay/Agreement • <br /> Bldglrl/Addn/Rem Size 10 re,.K.hill Nonresidential Use <br /> Garage/Accessory Struct.Size fo re w '\ Residential Use <br /> Number of Stories 10 ✓t Witht Proposed No.of Dwelling Units: . <br /> • <br /> Basement DNo Dyes, Fin!Unfln Total No.of Dwelling Units: • <br /> Type of Construction 74 Planning/Landscape Inspection Required before Final? DYes CINo • <br /> Occupancy Group t , "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load "WC School Impact Fee: Total $ , <br /> Cert.of Occpuancy Required? NaM CIYes DShell Only Calculated: , Credit: <br /> Cade Year 02021 'I201a EJ2015 (Everett School Dist DMukilteo School fist <br /> Fire Sprinklers:DUpdate Existing DNew System EfiNot Req'd Park.Impact Fees for permits applied for after 11112022: <br /> '• Reason Sprinklers Required: Park impact Fee Total$ ' (net due after credit for existing uses) • <br /> Fire Alarm: ElUpdate Existing Q New System VNot Req'd Fee,Sohedulle,Used For Calculation(Year), m� <br /> Reason Fire Alarm Required: � '!q( C\ <br /> RCW 64.55 MF worksheet req'd for permit? Yes El No nQ't /"" iJ 2's �" <br /> Add'I ROW.64.55 does required priorto final? )IYes NiNo Additional Notes: 0,, ,...... ���IJJ I cg2„,..,,,,,, <br /> q <br /> VALUATION CALCULATION: Total$ 7(70 • . <br /> Approved By: Date: <br /> • , <br /> . PUB.LICWORKS . <br /> Intake OK by: Date: <br /> • Intake Comments: PIN Review&Worksheet Needed if: <br /> • I 1ElSys Dev Eva!• <br /> DWater DSewer QStorm <br /> Additional Notes: • <br /> ❑Traffic Mitigation Evval, <br /> E <br /> Approved By: Date: -17/2c/2y - if Site Work/Drainage(shown/triggered) , <br /> . jiJAddrese Letter <br /> FIR?~'DI~PARMT NT f fBackflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary, <br /> Separate 1 Deferred Submittals Required: I hospital,supportive housing} <br /> OFire Sprinklers DFire Alarm ❑Other: I <br /> Additional Notes: El This Permit Is Approved by Public Works ' <br /> . El See PW Review Worksheet and associated attached items <br /> Fire Dept,Fees: 0 A Separate PW Permit is Required(Permit#:PW ) - <br /> El Review of As-Built Plans-NO FiRE FEE AND Q Is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE a Is located in this folder <br /> El Review/Inspection Scope-ADD FIRE FEE Ell Is in a Separate Green Folder(loin with this folderfor permit Issuance) <br /> Approved By: Date: . El Wiil be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> El Public Works has.no scope on this permit---PW Not Required <br /> • ELEGTRICAL!'PLUMDING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />