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Intake & Approval Sheet ( PERMIT STAFF ONO) I ZIT #—C�� `" D <br />BUILDING <br />Intake OK by: Date. <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/ e Size <br />K <br />Garage/Accessory Struct. Size <br />Number of Stories <br />1 <br />Basement <br />1�qNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group, <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />❑No KLYes []Shell Only <br />Code Year <br />112021 82018 ❑2015 <br />Fire Sprinklers: []Update Existing ❑New System ESNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing ❑New System 18Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes FD No <br />Add1 RCW. 64.55 docs required prior to final? ❑Yes ®No <br />VALUATION CALCULATION: Total $ �0 d <br />Additional Notes: <br />Approved By: &✓i Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑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 _2 27 <br />ELECTRICALIPLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: 17(A Date: M ,an 7,0 <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />A �� <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Sirs A F54 aQs?fcfvVA <br />Planning/Landscape Inspection Required before Final? ❑Yes 5ANo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ rJ I A <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukiltec School Dist <br />Park Impact Fees for permits applied for after 111/2022: <br />Park Impact Fee Total $ ') l h (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: 4 to G 6eds06wtS fie <br />Approved By: Date: 7,q ^ <br />PUBLIC WORKS <br />Intake OK by: Date: <br />.....w.,w,..,""'..W..........,._..._._.a..................__,._. �...,. _,.....,,.. <br />Intake Comments: PW Review & Worksheet Needed if• <br />❑Sys Dev Eval : <br />❑Water ❑Sewer ❑Storm <br />❑Traffic Mitigation Eval <br />'I]Site Work/Drainage (shownitriggered) <br />[]Address Letter <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />I <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 ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folderfor permit Issuance) <br />❑ WIII be issued separately (separate Green Folder, PW issued ahead of Bldg) <br />kublic Works has. no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed 13y: Date: j 70 2, <br />II • <br />