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, iii)-evis Go/QS fl-F-r6,g A-V) <br /> 514-i. <br /> Intake &Approval Sheet 01111 1 PERMIT STAFF ONLY) T# S030 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone /1/,(j <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size 1 Z'- Nonresidential Use "`— <br /> Garage/Accessory Struct.Size Li I Residential Use <br /> Number of Stories j Proposed No.of Dwelling Units: I <br /> Basementlo ❑Yes, Fin/Unfin Total No.of Dwelling Units: 7 <br /> Type of Construction 1 ('C PlanninglLandscape Inspection Required before Final? , Yes ❑No <br /> Occupancy Group 1 R.0 "In Lieu"Fee:Type: -•-- Amount$ '-"— <br /> Occupancy Load C School Impact Fee: Total $ /f %6 <br /> Cert.of Occpuancy Required? ❑No 1'es ❑Shell Only Calculated: ), Flo,d — Credit: _to_ <br /> Code Year 020021 g2018 ❑2015 ❑Everett School Dist Eqrfvlukilteo School Dist <br /> Me <br /> w <br /> Fire Sprinklers: ❑Update Existing I lew System Mot Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: TW V- Uos Park Impact Fee Total$ ,?j//"—(net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System §itiNot Req'd Fee Schedule Used For Calculation(Year): a!I Z K <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? oyes t No <br /> Add'I RCW.64.55 docs required prior to final? ❑Yes IgNo Additional Notes: $// 4,y4 ��/y <br /> VALUATION CALCULATION: Total$ 31� O,�a", <br /> t 6 Approved By: ,(A. '���— ate: ,2 —/ 07 !, <br /> `{ ( ) 6((4 r"6, (i PUBLIC WORKS <br /> 3I2 . 6 Z 0(K? Intake OK by: Date: <br /> Intake Comments: [PW Review&Worksheet Needed if: <br /> c (5; 034 I OSys Dev Eval: <br /> Additional Notes: ❑Water :hewer ❑Storm <br /> ,DTraffic Mitigation Eval <br /> Approved By: ,2Date: (2,124 /2.3 !Mite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT ;DBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Se <br /> pq Ihospital,supportive housing) <br /> El Fire Sprinklers El Fire Alarm DOther: I <br /> Additional Notes: 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 /> X-Review Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:X , /() Date12-lg...3 ❑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 /> ELEGTRICALIPLUMBING Additional Notes: <br /> Additional Notes: Y11) V ' \ 1-Ve6 U71/1 y <br /> Approved By: Date: Completed By:, 'f/ vlw,' V 1/V1.. Date: PAS 26Z3 <br /> i <br />