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Intake & Approval Sheet <br />jvl, cJdl>�. vk -t <br />(FOR PERMIT STAFF ONL1) <br />IA� <br />PERMIT #_ �)23 N " 01 <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 />' 6 4 qj ' <br />Garage/Accessory Struct. Size <br />Number of Stories? <br />^' <br />Basement <br />UNo ❑Yes , Fin / Unfin <br />Type of Construction <br />E-/L< <br />Occupancy Group <br />CWYt C <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />[]No 91Yes ❑Shell Only <br />Code Year <br />❑2021 172018 ❑2015 <br />Fire Sprinklers: ❑Update Existing New System ®Not Req'd <br />Reason Sprinklers Required: ki41 <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 19 No <br />Add'] RCW 64.55 docs required prior to final? ❑Yes glNo <br />VALUATION CALCULATION: Total $__^ <br />d r0'6 L/ <br />,e /(o6 �' 1J e", X 3 <br />4 <br />�r3, 7� �'� / a �Z 77 00 <br />i <br />Additional Notes: <br />r'"h BLS niT <br />Approved By: Date: <br />,;?-/;Z6'/"7u <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 />9 Review / Inspection Scope - ADD FIRE FEE <br />Approved By: W Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: Ed <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />IJ <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />fh . <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before F' al? Yes ❑No <br />.,In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ l 1 ,'6 44 U <br />Calculated: ]T$�lo Credit: <br />❑Everett School Dist ukilteo School Dist <br />Park Impact Fees for permits applied for after 1/112022: <br />Park Impact Fee Total $ 'LI Z O (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): �L9Z 3 <br />Additional Notes: <br />Approved By: <br />Date: 12 Z <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Review & Worksheet Needed if.• <br />❑Sys Dev Eval <br />I ❑Water ❑Sewer ❑Storm <br />I <br />❑Traffic Mitigation Eva] <br />I <br />[]Site Work/Drainage (shownitriggered) <br />i <br />❑Address Letter <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />1hospital, supportive housing) <br />I <br />I <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 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 By: Date: g f <br />A PJ�> lj2�,9!T _ ���� <br />,�vCk0 pf <br />4-�;Z 1A�;lo;?-1 <br />