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Intake & Approval Sheet (FOR PERMIT STAFF ONO) <br />PERMIT # <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 />Garage/Accessory Struct_ Size <br />$"S �� c t <br />Number of Stories <br />S� <br />Basement <br />©No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />u <br />Cert. of Occpuancy Required? <br />❑No ENYes ❑Shell Only <br />Code Year <br />❑2021 ®2018 ❑2015 <br />Fire Sprinklers: ❑Update Existing ONew System ❑Not Req'd <br />Reason Sprinklers Required: 17 D <br />Fire Alarm: Update Existing New System NNot 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 SNo <br />VALUATION CALCULATION: Total $ o2.77 %K <br />' 6 <br />Additional Notes: l,lkC( <br />R"it (/vi <br />Approved By: Date: <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 />rReview / Inspection Scope - ADD FIRE FEE <br />proved By: Date: <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 />� � C <br />Proposed No. of Dwelling Units: <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: k1 ,"L C edit: <br />❑Everett School Dist 5Mukil o School Dist <br />Park Impact Fees for permits app ed for after 1/1/2022: <br />Park Impact Fee Total $ '2WO (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): �23 <br />Additional Notes: <br />Approved By: ,j - Date: 17.,. Z <br />I <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: I pW Review & Worksheet Needed if., <br />❑Sys Dev Eval : <br />i❑Water ❑Sewer ❑Storm <br />I <br />❑Traffic Mitigation Eva[ <br />(❑Site Work/Drainage (shown/triggered) <br />1 ❑Address Letter <br />t❑Backflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />[ <br />15T <br />This Permit is Approved by Public Works <br />bfSee 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 loin with this folder for permit issuance) <br />❑ WIII 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: -1 1 L <br />