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unit C <br /> Intake & Approval Sheet (FOR PERMIT STAFF ON09 PERMIT# <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 S 4) Nonresidential Use <br /> Garage/Accessory Struct_Size s$`8 J t <br /> Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement E[No ❑Yes, Fin/Unfin Total No. of Dwelling Units: �j D <br /> Type of Construction Planning/Landscape Inspection Required beforekinab RYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amo t$ <br /> Occupancy Load �✓� School Impact Fee: Total $ b <br /> Cert.of Occpuancy Required? ❑Noy�es ❑Shell Only Calculated: �T�� Credit: <br /> Code Year ❑2021 012018 ❑2015 ❑Everett School Dist JKMuki eo School Dist <br /> Fire Sprinklers: ❑Update Existing ®New System JQNot Req'd Park Impact Fees for permits app red for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System ®Not Req'd Fee Schedule Used For Calculation(Year): <br /> --- -- <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 FL]No Additional Notes: <br /> VALUATION CALCULATION: Total$ 212 6 76 <br /> /'5 (o 17 5-5-9 6; S jApproved By: 1177Date: 1 <br /> xl�6Tx (06 + '3017 <br /> t,36 �� a? PUBLIC WORKS <br /> Intake OK by: Date:_ _ <br /> 76 Intake Comments: I PIN Review&Worksheet Needed if: <br /> / I❑Sys Dev Eval <br /> Additional Notes: (/.+lT L.ot +10Av1J1 — ❑Water ❑Sewer ❑Storm <br /> _ I <br /> �•�I✓1 7Yf�=,U�'I if ❑Traffic Mitigation Eva[ <br /> Approved By: Date: �' <br /> G1"�S p� /—� I❑Site Work/Drainage(shown/triggered) <br /> 1 <br /> ❑Address Letter <br /> FIRE DEPARTMENT ;❑Backflow Prevention for high hazard: <br /> t <br /> i(dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: ;hospital,supportive housing) <br /> ZFire Sprinklers ❑Fire Alarm ❑Other: I <br /> 4 <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 ElIs located in this folder <br /> E I Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: t v Date: El 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 By: Date: Q 'I <br />