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Intake & Approval Sheet (FOR PERMIT STAFF ONLY <br />i <br />ld9 A, LA T - <br />PERMIT# �b 2309 <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />BIdgTTI1Addn/Rem Size <br />15-7 <br />Garage/Accessory Struct. Size <br />5 4r4 <br />Number of Stories <br />3 <br />Basement <br />IMNo ❑Yes , Fin / Unfin <br />Type of Construction <br />ar'e-C <br />Occupancy Group <br />10L. to r <br />Occupancy Load <br />N ZA <br />Cert. of Occpuancy Required? <br />I ❑No ®Yes ❑Shell Only <br />Code Year <br />102021 02018 112015 <br />Fire Sprinklers: ❑Update Existing 1�iNewSystem El Not Req'd <br />Reason Sprinklers Required: `5 _ D <br />Fire Alarm: ❑Update Existing ❑New System Not Req'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 $ 307e2 <br />0 Ysv T 36 tau a3�v <br />Additional Notes: Vti /r <br />f C_4n 7`7'`L N U4 rr C —Si DC' Ll- "f7 i <br />Approved By: Date: 07 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />Review / Inspection Scope - ADD FIRE FEE <br />Approved By:., Date: �3 <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />�1n <br />Proposed No. of Dwelling Units: <br />1 <br />Total No. of Dwelling Units: <br />J 4-wg <br />Planning/Landscape Inspection Required b ore Final? Yes Wo <br />"In Lieu" Fee: Type: Plmoun $ <br />School Impact Fee: Total $ (p <br />Calculated:� *,4 (G Credit: <br />❑Everett School Dist QWukilteo School Dist <br />Park Impact Fees r permits plJiA'4 4-- ---er 1/112022: <br />Park Impact Fee Tot I > ��db at?esrKcre f foreriktinn „ces) <br />Fee Schedule Used or Calculation (Ye r): -___ Off- <br />----------------_ _-- - -- <br />Additional Notes: <br />Approved By: A" Date: M --7— <br />l) <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: �-----------------------.____..___________._ <br />I PW Review & Worksheet Needed if: <br />t ❑Sys Dev Eva] <br />❑Water ❑Sewer ❑Storm <br />I <br />❑Traffic Mitigation Eva] <br />❑Site Work/Drainage (shown/triggered) <br />❑Address Letter <br />I❑Backflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, <br />!hospital, supportive housing) <br />i <br />This Permit is Approved by Public Works <br />IKSee 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 Coin 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: 4SZq 123 <br />