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UnT 0 n;t- <br /> YN 1 L <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# ?j2-30$ , 015 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone , <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size d i6 Nonresidential Use <br /> Garage/Accessory Struct.Size j1,r" I- t 415( Residential Use <br /> Number of Stories 3L27 - Proposed No.of Dwelling Units: <br /> Basement ®No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required b fore Final? ❑Yes Flo <br /> Occupancy Group ELF "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load h t School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No TRYes ❑Shell Only Calculated: 1\i%k b Credit: <br /> Code Year 102021 M2018 112015 ❑Everett School Dist qMukilte School Dist <br /> Fire Sprinklers: ❑Update Existing ONew System NNot Req'd Park Impact Fees f permits appl for after 1/1/2022: <br /> Reason Sprinklers Required: — no Park Impact Fee Tota $ Z Z 0 et due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing New System MNot Req'd Fee Schedule Used r Calculation(Year) L 3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> z� Add'I RCW 64.55 docs required prior to final? ❑Yes -WNo Additional Notes: <br /> VALUATION CALCULATION: Total$ ' <br /> __,57� 7 -! Approved By: 41 <br /> Date: Z,1— L— <br /> ,r G -i 38 <br /> PUBLIC WORKS <br /> / Intake OK by: Date__ <br /> 77'f Intake Comments: I PW Review&Worksheet Needed if: <br /> 0?97 <br /> ❑Sys Dev Eval <br /> dditional Notes: �L�6✓� (/^IT TTIX-- I ❑Water ❑Sewer ❑Storrs <br /> i <br /> v%% 7T .SoS.Pjoi icl^ ❑Traffic Mitigation Eval <br /> Approved By: L Date: 1 LsL; I❑Site Work/Drainage(shown/triggered) <br /> !❑Address Letter <br /> FIRE DEPARTMENT Backflow Prevention for high hazard: <br /> !(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: [hospital,supportive housing) <br /> Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> r <br /> Review/Inspection Scope-ADD FIRE FEE ElIs in a Separate Green Folder Qoin with this folderfor permit issuance) <br /> proved By: Date: - ❑ 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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed B Date: <br /> C,1-1A 46P5 ROL) C'*7- <br />