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Intake &Approval Sheet R PERMIT STAFF ONLY) .MIT# L Y/—0.�/ <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 ❑ SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size c-i-- - Nonresidential Use <br /> Garage/Accessory Struct.Size N It Residential Use Y/ <br /> Number of Stories '3 Proposed No.of Dwelling Units: / <br /> Basement WNo ❑Yes, Fin/Unfin Total No.of Dwelling Units: / <br /> Type of Construction t R.C. Planning/Landscape Inspection Required before Final? crYes ❑No <br /> Occupancy Group 1 R-C "In Lieu"Fee:Type: I--- Amount$ <br /> Occupancy Load 1P-G School Impact Fee: Total $ ///61 <br /> Cert.of Occpuancy Required? ONo ,Yes ❑Shell Only Calculated: /,l jG/� Credit: �$- <br /> Code Year 1=120 1 Ef2018 02015 ❑Everett School Dist I?'t iukilteo School Dist <br /> Fire Sprinklers: El Update Existing 11 New System Mot Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: '1H S* VNI TC Park Impact Fee Total$ 3 33/ (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing❑New System 'Not Req'd Fee Schedule Used For Calculation(Year): .2 a L <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes �,(No Aeikl Add'I RCW 64.55 docs required prior to final? ❑Yes <br /> Additional Notes: c1a/"` A 7VALUATION CALCULATION: Total$ �'2 `i-‘/.,.,:fii <br /> r `k \ 6 c — Va.t to%Z . Approved By: 16.7 v Date: .2 -/..i' ae <br /> 1 K (Q Lk _ 7.,6,1 soLk PUBLIC WORKS <br /> Intake OK by: Date: <br /> talk �g Intake Comments: <br /> -70 <br /> 2 \( _ PW Review&Worksheet Needed if: <br /> /`' jDSys Dev Eval: <br /> 3�5, 03`� I <br /> Additional Notes: 1 OWater OSewer OStorm <br /> IDTraffic Mitigation Eval <br /> Approved B Date: (212//z i DSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> pq hospital,supportive housing) <br /> El Fire Sprinklers El Fire Alarm El Other: <br /> Additional Notes: 04 This Permit is Approved by Public Works <br /> . ❑See PW Review Worksheet and associated attached items <br /> Fire Dept,Fees: 0 A Separate PW Permit is Required(Permit#:PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑l Minimal or No Fire Scope-NO FIRE FEE El Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By:V ,Ar�,„in Date: L2_/ '.2,23 ❑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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: ADS Vh're.tik i�L,/ <br /> Approved By: Date: Completed ByCjjamvur,elitAluovkgate: t L 1 ti, 22,23 <br />