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Intake & Approval Sheet <br />,..OR PERMIT STAFF ONLY) RMIT 7 "-, 03> <br />BUILDING <br />intake OK by: Date: <br />Intake Comments: <br />❑ Meke this a "W" Permit <br />❑ SRC Required (Pra•1 sp) <br />Bldgf I/Addn/Rem Size <br />O OGG <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />JfNo C1Yes , Fin / Unfin <br />Type of Construction <br />— <br />Occupancy Group <br />I <br />Occupancy Load <br />XoAn'Yes <br />Cert, of Orepuancy Required? <br />❑Shell Only <br />Code Year <br />112021 018 1_12015 <br />Fire Sprinklers: pdate Existing ONew System ❑Not Req'd <br />Reason Sprinkles Required' X_ AL.1MXD <br />Fire Alarm: Update Existing 1]New System E]Not Req'd <br />Reason Fire Alarm Required: /�' 69MI-b <br />RCW 64.55 MF worksheet req'd for permit? []Yes 19No <br />Add'I ROW.64.65 docs required prior to final? E]Yes Mo <br />VAEUATION CALCULNI7oN: Total $ �9C� <br />Additional Notes: <br />Approved By: Date:( <br />FIR); DEOARTWNT <br />Separate 1 Deferred Submittals Required: <br />OFire Sprinklers E]Ffre Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />1l Review of As -Built Plans •• NO FIRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />1] Review / inspection Scope ..ADD FIRE FEE <br />Approved Hy: Date: <br />P1.PCTR(CALiPLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: P, bate: U Z0 ZU <br />Intake Comme <br />Zone <br />! I L <br />Overlay/Agreement IA <br />IA 4LA <br />Nonresidential Use <br />N ► h (n u i c�.1 <br />Residential Use <br />r <br />Proposed No. of Dwelling Units: <br />Total No, of Dwelling Units: <br />Planningli-andscape Inspection Required before Final? 11Yes ONo <br />"In lieu" Fee: Type: Amount $ 0 <br />School Impact Fee: Total $ D <br />Calculated: Credit: <br />DEverett School Dist ElMukliteo School Dist <br />Park impact Fees for permits applied for after 111/2.022' <br />Park Impact Fee Total $ O (net due after credit for existing uses) ' <br />Fee Schedule Used For Calculation (Year)uw���A�v ^ wu p 4 v ^M^ <br />Additional Notes: <br />Approved By: Date:3 ZG Z <br />' PUBLIC WORKS <br />Intake OK by: Date; <br />Intake Comments: PWReview & Worksheet Needed if• <br />E(Sys Dev Eval : _ <br />UWater Usewer Elstorm <br />UTraffic Mitigation Eval <br />ESlte Work/Drainage (shownftdggered) <br />ETAddress letter <br />E(Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />This Permit Is Approved by Public Works <br />El See PW Review Worksheet and associated attached Items <br />C1 A Separate PW Permit is Required (Permit#: PW ) <br />AND ❑ Is fully digital <br />C1 Is located In this folder <br />C1 Is in a Separate Green Folder (join vrith this foldarfor permit Issuance) <br />0 Will be Issued separately (separate Green Folder, PW issued ahead of Bldg) <br />1� Public Works has.no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed By: <br />iyt 1^_ Date: 1131 124 <br />U U <br />