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Intake & Approval Sheet <br />(FOR PERMIT STAFF ONLI) <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />,,.' CR5 LP <br />Garage/Accessory Struct. Size <br />- <„e: � r <br />Number of Stories <br />31t7 .3 <br />Basement <br />9TNo ❑Yes , Fin / Unfin <br />Type of Construction <br />PIZ.G <br />Occupancy Group <br />�iiltcer G <br />Occupancy Load <br />N //� <br />Cert. of Occpuancy Required? <br />❑No ®Yes ❑Shell Only <br />Code Year <br />❑2021 ®2018 ❑2015 <br />Fire Sprinklers: ❑Update Existing ❑New System []Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update F dsting ❑New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add1 RCW 64.55 docs required prior to final? ❑Yes IF]No <br />VALUATION CALCULATION:_ Total $ <br />J �f7 <br />l66 it x66 Y�y <br />;?,:7 otca 35—S76 <br />0770111/1Y r 7,P X7 <br />Additional Notes: of UhT( Lr-r Vo9ZV1A0' <br />lT ` c ' <br />Approved By: L Date: /Aa3 <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 />Linimal or No Fire Scope - NO FIRE FEE <br />eview/ Inspection Scope -ADD FIRE FEE <br />oved By: r Minimal <br />ELECTRICALIPLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PERMIT # ���� v Olt <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />C AAN' 12,X <br />Planning/Landscape Inspection Required before Final? ❑Y s ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 1 `b <br />Calculated: X'i r UI (" Credit: CIS- <br />DEverett School Dist 5dMukiltec School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ 771910 (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): Z3 <br />Additional Notes: <br />Approved By: IL .)3�7 Date: I Z • 7• L <br />u <br />PUBLIC WORKS <br />Intake OK by: Date: ____ <br />Intake Comments: �PW Reviews Worksheef Needed if. <br />❑Sys Dev Eva[ <br />Ij ❑Water ❑Sewer ❑Storm <br />i <br />i❑Traffic Mitigation Eva] <br />I❑Site Work/Drainage (shown/triggered) <br />I ❑Address Letter <br />I ❑Backflow Prevention for high hazard: <br />((dental, medical, animals, mortuary, <br />![hospital, supportive housing) <br />Wi <br />, This Permit is Approved by Public Works <br />I�1 See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND Ells fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder Coin with this folderfor permit issuance) <br />❑ 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 />Additional Notes: <br />Completed By. Date: 177= <br />Ato-ro - F-j w a o�,-mine- 'R6 <br />CN�nf�S /H ,�?�✓� t /�I �ll VlKULr�� <br />