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Intake &Approval Sheet (FOR PERMIT STAFF ONO) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date:Z/ZZ %4 <br /> Intake Comments: intake Comma ts: <br /> Zone WL <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement ACA., <br /> Bldg/Tl/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size or— Residential Use <br /> Number of Stories 1• Proposed No.of Dwelling Units: <br /> Basement o []Yes, Fin/Unfln Total No.of Dwelling Units: ' <br /> Type of Construction -13 Planning/Landscape Inspection Required before Final? ❑Yes MNo <br /> Occupancy Group - "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? RNo ❑Yes []Shell Only Calculated: Credit: <br /> Code Year 102021 02018 02015 ❑Everett School Dist ❑Mukiltec School Dist <br /> Fire Sprinklers: Update Existing❑New System []Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for exisUng uses) <br /> Fire Alarm: VgUpdate Existing[]New System ❑Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes KNo <br /> Addl RCW.64.55 does required prior to final? ❑Yes ERNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 00 <br /> Approved By: Date: ZZ Z`i <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: eview&Worksheet Needed if,j ---- <br /> DSys Dev Eval: <br /> Additional Notes: jj E]Water ❑Sewer ❑Storm <br /> L ►E]Traffic Mitigation Eval <br /> , <br /> Approved BX; i[]Site Work/Drainage(shown/triggered) <br /> DAddress Letter <br /> FIRE DEOARTM8NT' DBacktiow Prevention for high hazard: <br /> Separate 1 Deferred Submittals Required: `(dental,medical,animals,mortuary, <br /> p q hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm []Other: <br /> Additional Notes: Q This Permit is Approved by Public Works <br /> ❑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 /> ? -Review/Inspection Scope-ADD FiRE FEE 1❑ Is in a Separate Green Folder(torn with this folder for permit Issuance) <br /> Approved By.< � --�p� L_Date: .1 Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> P�pblic Works has.no scope on this permit---PW Not Required <br /> EILEGTRICALIPLUMB.ING Additional Notes: <br /> Additional Notes: I ` <br /> Approved By: Date: Completed iV zo z- <br />