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Intake &Approval Sheet OR PERMIT STAFF QNL 9 ` RMIT# K�1 ?3 03,6 <br />BUILDING <br />intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit <br />❑ SRC Required (Pre-lnsp) <br />Bldg1Tl/Addn1Rem Slze <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No CIYes , Fin / Unfin <br />Type of Construction <br />IL <br />Occupancy Group <br />Occupancy Load <br />-T R-u <br />Celt, of Occppancy Required? <br />19No ElYes QShell Only <br />Cade Year <br />102021 192018 [12015 <br />Fire Sprinklers: ❑Update Existing []New System $Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: I_tUpdate Existing ❑New System ' 9Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for perrriit? F]Yes +� No <br />Addl RCW. 64.55 docs required prior to final? OYes PNo <br />VALUATION CALCULATION: Total $^`•i 3I ti-.�) <br />Additional Notes: <br />Approved By; Date; <br />FII21r DEPARTMi~Nf <br />Separate I Deferred Submittals Required: <br />Fire Sprinklers ❑Fire Alarm ❑Other. <br />Additional Notes: <br />Fire Dept. Fees: <br />a Review of As -Built Plans - NO FIRE FEE <br />Ll Minimal or No Fire Scope - NO FIRE FEE <br />El Review I inspection Scope -ADD FIRE FEE <br />Approved By: Date: <br />ULEf T.RICALIALUMI3ING <br />Additional Notes: <br />Approved By; Date: <br />PLAmMNG <br />C <br />Intake OK by: Assign To: � Date: 2 <br />Intake Comments: <br />Zone <br />—s , <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />LS <br />Proposed No. of Dwelling Units: <br />fi0 <br />Total No. of Swelling Units: <br />Planning/Landscape Inspection Required before Final? CIYes JKNo <br />"in Lleu" Fee: Type: Amount $ <br />School Impact Fee: Total $4. ' <br />Calculated: Credit: <br />Everett School Dist ❑Mukiltee School Dist <br />Park Impact Fees for permits applied for after'11112022: <br />Park impact Fee Total (net due after credit for existing uses) ' <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: L p-v Sc�e rtA ova <br />Approved By:� Date: 3 2. <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments; PWReviexr & WorksheeiNeeded if• w <br />❑Sys Dev Eval : _ <br />❑Water bSewer ElStorrn <br />❑Traffic Mitigation Eval, <br />USite WorWOrainage (showniriggered) <br />1[(Address Letter <br />08ackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />Q A Separate PW Permit is Required (Permit#: PW ) <br />AND a Is fully digital <br />d Is located In this folder <br />p is in a Separate Green Folder aofrrwlththrsfolderforpermit issuance) <br />EJ Will be Issued Separately (separate Green Folder; PW fssued ahead of Bldg) <br />El Public Works has.no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed By: Date: <br />