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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT # 8 Z363 C40 <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 />S - <br />Garage/Accessory Struct. Size <br />j f� c 4 `(ff o k <br />Number of Stories <br />3 <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction, <br />Occupancy Group <br />�c wkl�dGt�C <br />Occupancy Load <br />/v <br />Cert. of Occpuancy Required? <br />❑No SYeS ❑Shell Only <br />Code Year <br />112021 02018 112015 <br />Fire Sprinklers: El Update Existing - New System ❑Not Req'd <br />Reason Sprinklers Required: 13 —0 <br />Fire Alarm: El Update Existing ❑New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ED No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes nNo <br />VALUATION CALCULATION: Total $ a 0,21 (e/ r <br />/cS J Cl Sf c 445 <br />177, IV <br />Additional Notes: !J-i'T" 2—FT <br />Oki <br />Approved By: Date: ; <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />,a 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 />eview / Inspection Scope - ADD FIRE FEE <br />Approved By: lrjDate: <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 />,�- <br />Proposed No. of Dwelling Units: <br />l <br />Total No. of Dwelling Units: <br />`7 <br />Planning/Landscape Inspection Required before Final? ❑Yes WNo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 1 (o <br />Calculated: �1 . '614{,y Credit: <br />❑Everett School Dist qMukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ lil-hO (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): 1013 <br />Additional Notes: <br />Approved By: �— ,NDate: i Z .% Z <br />W <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Review & Worksheet Needed if.- <br />❑Sys Dev Eva[ <br />t <br />❑Water ❑Sewer ❑Storm <br />l <br />j❑Traffic Mitigation Eva[ <br />i❑Site Work/Drainage (shown/triggered) <br />i ❑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 />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 B . Date: E 1-Z 9 Ze <br />