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Intake & Approval Sheet <br />PERMIT STAFF ONLY) ply IT # Fz; <br />BUILDING <br />intake OK by: Date: <br />intake Comments: <br />❑ Make this a "W" Permit <br />❑ SRC Required (Pre-Insp) <br />Bld ddn/Rem Size <br />Da f - <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />[Io ❑YeS , Fin 1 l.Infin <br />Type of Construction <br />( 4> c hi q 1 <br />Occupancy Group <br />5 . A `3 , <br />Occupancy Load <br />ge,ktai n <br />Cett. of Occpuancy Required? <br />14No OYes ❑Shell Only <br />Code Year <br />112021 M018 112015 <br />Fire Sprinklers: RUpdate Existing LINew system []Not Req'd <br />Reason Sprinklers Required: Pr'a [P VL';r <br />Fire Alarm: ISUpdate Existing []NewSystem E]Not Req'd <br />Reason Fire Alarm Required: AQAJ <br />Uw <br />RCW 64.55 MF worksheet req'd for permit? OVes 1W No <br />ME RCW. 64.55 does required prior to final? ElYes JANS <br />VALUATION CALCULATION: Total $ O ate <br />Additional Notes: <br />Approved By: Date: p <br />I% <br />Fftili DEOARMNT <br />Separate l D eferred Submittals Required: <br />❑Fire Sprinklers Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />E]Review of As -Built Plans - NO FiRE FEE <br />El Minimal or No Fire Scope - NO FIRE FEE <br />iQ Review/ inspection Scope -ADD FIRE FEE <br />Approved By: Date: <br />ELEGTR(CAL/PLUMBING <br />Additional Notes: <br />Approved By: Vate: <br />PLANNING <br />Intake OK by: Assign To:. U'h Date; AU.1611% <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes MNo <br />"in Lieu" Fee: Type: Amount $ 41 * <br />School impact Fee: Total $ N 1A <br />Calculated: Credit: <br />DEverett School Dist IIMukiltee School Dist <br />Park Impact Fees.for permits applied for after 111/2022; <br />Park impact Fee Total $ N (A (net due after credit for existing uses) ' <br />Fee Schedule Used For Calculation (Year);m�„��-.r.......... , <br />Additional Notes: <br />Approved By. Date: 4. f1Awrtk <br />PUB.LIC WORKS <br />Intake OK by: Date: _ _ _ _ <br />Intake Comments; �AWReviear & Worksheef Neededif <br />ClSys Dev Eval : <br />❑Water (-/Sewer ❑Storm <br />ClTraffic Mitigation Eval <br />jUSite WorldDrainage (shown/triggered) <br />�QAddress Letter <br />rOBacktlow 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 />El A Separate PW Permit is Required (Permit/#; PW ) <br />AND ❑ Is fully digital <br />El Is located In this folder <br />ISM a Separate Green Folder Uoinwlth this foiderforpermit issuance) <br />El Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />U�Rubllc; Works has.no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed >3y: Date: pZ 2 4- It, <br />