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Intake & ,Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT# &)Q4 0 -�> I LfS✓ <br />BUILDING <br />intake OK by: Date: <br />Intake Comments: <br />❑ Make thle a "W" Permit <br />❑ 5RC Required (pre-Insp) <br />13ldgITl/AddnlRem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />[]No KYasjZy Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cott, of Occppancy Required? <br />1KNo UYes }Shell Only <br />Code Year <br />IM202i 112018 112016 <br />Fire Sprinklers:0-Update Existing EINew System RNat Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update ExistingONewSystem RNotReq'd <br />Reason Fire Alarm Required: <br />ROW 64.55 MF worksheet req'd for permit? ElYes M No <br />Add`I RCW. e4.55 does required prior to final? ElYes RNo <br />VA:UATION CALCULATION: Total $ �s�� 0 bb <br />Additicnal Notes: <br />Approved By: Date: Li 1110 <br />?; IR�'I)I;1�ACTM�IVT' <br />Separate I Deferred Submittals Required: <br />OFlre Sprinklers LIFire Alarm ❑Other: <br />Additional Notes: <br />Eire Dept. Fees: <br />11 Review of As -Built Plans - NO FiRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />Review/Inspection Scope -ADD FIRE FEE <br />Approved ;3y: Data. <br />E,L50TRICAL/PLUM DING <br />Additional Notes: <br />Approved By: Date: <br />INNING <br />Intake OK by:l Assign To: 3e ss Date: 4 Iz vi <br />intake Comments: <br />Zone <br />Overlay/Agreement <br />lu 1A <br />Nonresidential Use <br />Residential Use <br />F IL <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planningll andscape Inspection Required before Final? 0Yes [ANo <br />"in Lieu" Fee: Type: Amount $ O <br />School Impact Fee: Total $ 0 <br />Calculated: Credit: <br />[]Everett School Dist E]Mukiltea School Dist <br />Park Impact Pees for permits applied for after 11112022: <br />Park impact Fee Total $ .(net due after credit for existing uses) <br />Fee Schedule ,Used For calculation (Year);n�ua��nv^nV�„��^nV�Pn��vN <br />Additional Notes: <br />Approved By: Date: H %1 Z AZw <br />f IV <br />' PUBLIG-MRK8 <br />Intake OK by: <br />EDate: _ <br />Intake Comments: lPWRaview&WorkshaetNeededif- <br />�CISys Dev Eval <br />QWater ElSewer Elstorm <br />{i <br />)_ITraffic Mitigation Eval, <br />ClSite Work/Drainage (shownitriggered) <br />lElAddress Letter <br />t FlBackffow Prevention for high hazard: <br />l(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />F <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 />0 Is located in this folder <br />EJ Is in a Separate Green Folder qoinw;ththlaiolderforpermittssuance) <br />El Will be issued separately (Separate Green Folder, PW issued ahead of 3ldg) <br />Public Works has.no scope an this permit--- PW Not Required <br />Additional Notes: <br />I <br />Completed 13y: <br />te: 0Li t 0e? <br />'UL <br />