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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT k52JkL3 �V k <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 0 SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size 1 '} Nonresidential Use <br /> Garage/Accessory Struct. Sized Residential Use <br /> Number of Stories 3k Proposed No. of Dwelling Units: <br /> Basement _❑No ❑Yes , Fin/Unfin Total No. of Dwelling Units: <br /> Type of Construction , Planning/Landscape Inspection Required before Final )Yes ❑No <br /> Occupancy Group "In Lieu" Fee: Type: Amount$ ' <br /> Occupancy Load Sj..., School Impact Fee: Total $ (J ,f6 <br /> Cert. of Occpuancy Required? ❑No ®Yes ❑Shell Only Calculated: -2 (Yc,. Credit: <br /> Code Year 1:12021 1Z12018 1:12015Everett School Dist ❑Mukilteo S ool Dist <br /> Fire Sprinklers: ❑Update Existing El New System Not Req'd Park Impact Fees for permits applied r after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ 3-0/ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): 33,3/ <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes J No <br /> Add'I RCW 64.55 docs required prior to final? Oyes No Additional Notes: <br /> VALUATION CALCULATION: Total $ �?} e(tiD <br /> ��g �� Approved By: �� L Date: j!-4 - z <br /> , <br /> oiNt PUBLIC WORKS <br /> Intake OK by: Date: <br /> 3 ')&—k 11k, Intake Comments: PW Review&Worksheet Needed if. <br /> ❑Sys Dev Eval : <br /> Additional Notes: <br /> ❑Water Sewer ❑Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: I A f,, Date: 41111 ❑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: :hospital,supportive housing) <br /> ❑Fire Sprinklers El Fire Alarm ❑Other: <br /> Additional Notes: 01 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 2 4 o L 8) <br /> ❑ Review of As-Built Plans -NO FIRE FEE AND ❑ Is fully digital <br /> ▪ Minimal or No Fire Scope-NO FIRE FEE 74 Is located in this folder <br /> O Review/ Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: t�k)c�bvn Date: "3-,2, ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope on this permit--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed B ,����T Date: s5(i'7 f2..i1--4— <br />