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Intake & Approval Sheet FOR PERMIT STAFF ONLY) <br />ERMIT # `f' �0 <br />13UILDING <br />intake OK by: pate: <br />Intake Comments: <br />❑ Make this a "W" Permit <br />❑ 5RC Required (Pre-Inap) <br />13ldg/TI/Addn/Rem Size- <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No [(Ye , Fin 1 Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />ZNo ElYes 119helI Only <br />Code Year <br />102021 M2018 Q2015 <br />Fire Sprinklers: ❑Update Existing ONew System <br />PRN,t Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing QNew System MNot Req'd <br />Reason Fire Alarm Required: <br />RGW 64.55 MF worksheet req'd for permit? CIYes K No <br />Add'I RGW. 64.55 docs required prior to final? ❑Yes o <br />VAE IATION CALCULATION. Total <br />�'f-fg <br />Additional Notes: <br />Approved By age: `�j7/ 2 <br />Pl[2 . DI;PAR MINT <br />Separate I Deferred Submittals Required: <br />Fire Sprinklers ®Fire Alarm []Other. <br />Additional Notes: <br />Fire Dept. Fees: <br />0 Review of As -Built Plans - NO FIRE FEE <br />L1 Minimal or No Fire Scope - NO FIRE FEE <br />Review IInspection Scope -ADD FIRE FEE <br />Approved By; Dat2a <br />ELEG-TRICALIPLUMBING <br />Additional Notes: <br />Approved By: Date: <br />1- ,j MtdNING <br />Intake OK by: Assign To: Date; <br />Intake Comments: <br />Zone <br />p, . <br />Overlay/Agreement <br />AAA, .4 A CA <br />Nonresidential Use <br />Residential Use <br />L <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes wo <br />"In lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 'fJ <br />Calculated: <br />[]Everett School Dist ukllteo School Dist <br />Park lmpact Fees for permits applied for aft 1112022: <br />Park Impact Fee Total $ ft, ue after credit for existing uses) <br />Fee Schedule Used For Calculation <br />Additional Notes: <br />Approved By: Date:—ajl�ZL{ <br />W <br />PUB.LIG WORKS <br />Intake OK by: Date: _ <br />Intake Comments: PWRevietiu&WorksheefNeeded if•,.M...a <br />ys Dev Eval : <br />1 ❑Water b8ewer torm <br />CL TQ rr b a_VtC.e1 ElTraffic Mitigation Eval, <br />-Ar S (dZ U, 1 t ' [E(Site WorklDrainage (shown/triggered) <br />()P-367 -s s f QAddress Letter <br />pBackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />J This Permit is Approved by Public Works <br />KSee PW Review Worksheet and associated attached items <br />El A Separate PW Permit is Required (Permit#: PW ) <br />AN13 Q Is fully digital <br />Is located in this folder <br />Is in a Separate Green Folder Qoinwiththis folderforpermit Issuance) <br />Will be issued separately (separate Green Folder, PW Issued ahead of Bldg) <br />p Public Works has•na scope on this permit--- PW Not Required <br />Additional Notes: <br />completed By. �� � Date: e! oZ,0 <br />V <br />