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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size%090 <br />Garage/Accessory Struct. Size <br />q (� <br />Number of Stories <br />�. <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />T_(LL, <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />❑No RlYes ❑Shell Only <br />Code Year <br />112021 ®.2018 112015 <br />Fire Sprinklers: ❑Update Existing ❑New System QNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System RNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? []Yes No <br />c® <br />Add'I RCW 64.55 docs required prior to final? ❑Yes w No <br />VALUATION CALCULATION: Total $ <br />(°�b%0001= <br />Additional Notes: <br />Approved By: Date: f L, i l <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ 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 By: Date: q —.�7_ 3 <br />ELECTRICAL/PLUMBING, <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To:_]�, Date: IZ 3 <br />Intake Comments: <br />Zone <br />- Z <br />OverlaylAgreement <br />war(no(c. a <br />Nonresidential Use <br />Residential Use <br />GS <br />Proposed No. of Dwelling Units: <br />Total No, of Dwelling Units: <br />Planning/Landscape Inspection Required Vefore Final? Yes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 13 b Z <br />Calculated: 8$ 02: U49 Cre it: 62a16 V- 5F9 <br />Everett School Dist ❑Mukilte School Dist <br />Park Impact Fees for permits appli d for after 1/112022: <br />Park Impact Fee Total 24 O (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): 2 bZ3 <br />3(-06x 2 = 63 (o o — 2 12-o ( <br />Additional Notes: 100t faf t <br />be. r� � �c.7• v vtotie.,r � `�i-e�w..El— . <br />Approved By:��� Date: 3 ya Z <br />PUBLIC WORKS <br />Intake OK by: Date: 6 1 1-1,13'ro 12PUA <br />Intake Comments: PIN Review & Worksheet Needed if: <br />F]Sys Dev Eva[ : <br />NfWater Sewer Storm <br />OTraffic Mitigation Eval <br />I9Site Work/Drai,age(shown/triggered) <br />®Address 11LLYVetttteLer <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <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 2 -I I_-0 �J ) <br />AND 9 Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folder for permit Issuance) <br />0 Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: JUTWA4,, Date: 0�ja b <br />