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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (52309— U11 <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 /5r6 j Nonresidential Use <br /> Garage/Accessory Struct.Size, ,) C Residential Use mol h_ h <br /> Number of Stories 3 Proposed No.of Dwelling Units: <br /> Basement 13No ❑Yes, Fin/Unfin Total No.of Dwelling Units: M <br /> Type of Construction Z k- Planning/Landscape Inspection Required before final? Yes []No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? ❑No ®Yes ❑Shell Only Calculated: \ , Q 4 L- Credit: 0 <br /> Code Year ❑2021 02018 1:12015 ❑Everett School Dist ,MMukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ®New System.allot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: �w t' Park Impact Fee Total$ 71"60 (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): Z_,6Z-3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes UNo <br /> Add']RCW 64.55 docs required prior to final? ❑Yes EtNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 0,71 , 67E <br /> 1,Z'I r,f 8 63 Approved By: Date: I L- (� <br /> + a, 39Y <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if., <br /> / El Sys Dev Eval: <br /> Additional Notes: UrtCT LGt" ,S4/$.Dit1d!tx- ❑Water ❑Sewer ❑Storm <br /> f <br /> ".'! C t❑Traffic Mitigation Eva] <br /> Approved By: Date: 3 !❑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: 1hospital,supportive housing) <br /> `Fire Sprinklers ❑Fire Alarm ❑Other: j <br /> Additional Notes: This Permit is Approved by Public Works <br /> 19 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 /> eview/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder 6oln with this folderfor permit issuance) <br /> Approved By: p Date: - 3 ❑ 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: -r ,, <br />