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?� IWT -v <br /> Intake &Approval Sheet ISGQ�S PERMIT STAFF ONLY)AiPROvA IT# a".3© per <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone "1/.D <br /> ❑ Make this a"W"Permit 0 SRC Required(Pre-lnsp) Overlay/Agreement • <br /> Bldg/TI/Addn/Rem Size \7Z '.i— Nonresidential Use <br /> Garage/Accessory Struct.Size y 1 Residential Use 1/ <br /> Number of Stories Proposed No.of Dwelling Units: / <br /> Basement .-No ❑Yes, Fin/Unfin Total No.of Dwelling Units: / <br /> Type of Construction 1'CL C Planning/Landscape Inspection Required before Final? BYeS ❑No <br /> Occupancy Group 1 R C "In Lieu"Fee:Type: --- Amount$ — <br /> Occupancy Load t R C School Impact Fee: Total $ /fj J5' <br /> Cert.of Occpuancy Required? ❑No MYes ❑Shell Only Calculated: & d'7 . Credit: .Q <br /> Code Year ❑20 1 -20118 02015 ❑Everett School Dist amukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing L"1New System ONot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: 5+ Vey(? Park Impact Fee Total$ 33.7/i (net due after credit for existing uses) <br /> pExisting ONew System,Not Req'd Fee Schedule Used For Calculation(Year): U Z, <br /> Fire Alarm: ❑U date <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for permit? ❑Yes No l <br /> Add'I RCW.64.55 does required prior to final? ❑Yes o Additional Notes: i(,f,2; Ja)'`"�e% <br /> VALUATION CALCULATION: Total$ r �j/,J ,fib <br /> Approved By: �,ee./- Date Z /7j=Zj <br /> P A 7 x t66 — c), g-6 cv, <br /> LI <( )4- 6 c ✓ 02C 3 PUBLIC WORKS <br /> 3.a' 7L 6-1 — 0 4 F Intake OK by: Date: <br /> Intake Comments: 1PW Review&Worksheet Needed if: <br /> " �3( . o3/`7 ,'ElSys Dev Eval: <br /> Additional Notes: :Water ❑Sewer ❑Storm <br /> OTrafFic Mitigation Eval <br /> Approved By: Date: 12 (2_c/L5 ' Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> • <br /> Separate/Deferred Submittals Required: !hospit ,medical,r animals,mortuary,hospital,supportive housing) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: 151 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 /> ..eview/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit Issuance) <br /> Approved By: K i glet,,/I'1 Date: ), -/-- ❑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: ro g '0r' I , „Vi 51n N <br /> Approved By: Date: Completed By: , t jnMAtAik}Date: OA 1 1Zo2,3 <br />