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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#_ <br /> BUILDING I PLANNING <br /> intake OK by: _ Date: Intake OK by: Assign To' Date: <br /> Intake Comments: Intake Comments: <br /> - Zone �A <br /> s re-e. ,Stdewatk%pew c-� -1 <br /> ❑Make this a"W"Permit ❑SRC Required Pre•Insp) I Overlay/Agreement un <br /> Bldg1Tl/AddnlRem Size <br /> K 9 � Nonresidential Use reFc�tt s41es 8.sect/�c,es <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement lNo CIYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of construction Pianningll-andscape inspection Required before l;final? ElYes EINo <br /> Occu ancy Grou � , <br /> "in Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee; Total $ <br /> Cart.of Occppancy Required? No byes ❑Shell Only Calculated: Credit: <br /> Cade Year <br /> U2D21 <br /> 2018 02015 [Everett School Dist [(Mukiltec School Dist <br /> Fire Sprinklers; Update Existing[]New System [ Not Req d Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Patio Impact Fee Total t� (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing❑New System UNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF Nvorksheet req'd for permtt? UYes No <br /> Add1 RCW 64.55 does required prior to final? E]Yes [No Additional Notes: <br /> vALUATIONCALCULATION: Total$^ S' 4�1 pate: z�27f'24 <br /> Approved By: <br /> PUBLIC•11N012KS <br /> Intake OK by: Date: <br /> Intake Comments: PWKeview&Warksheet Needed If. <br /> []Sys Dev Eval: <br /> ❑Water QSewer QStorm <br /> Additional Notes: <br /> []Traffic Mitigation Eval <br /> Approved By: ,,, ���,, pate: 'l ( '[]site Work/Drainage(shownitriggered) <br /> QAddress Letter <br /> I;IR)r DEpARTIVIM QBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate I Deferred Submittals Required: hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other:•___.— ' <br /> Additional Notes: This Permit Is Approved by Public Works <br /> See PW Review Warksheet and associated attached Items <br /> Fire Dept.Fees: ❑A Separate PW Permit:is Required(Permit#.PW ) <br /> El Review of As-Built Plans••NO FIRE FEE AND ❑ is fully digital <br /> Minimal or No Fire Scope--NO FIRE FEE <br /> p is located In this folder <br /> p Review/inspection Scope-ADD FIRE FEE El IsIs in a Separate Green Folder(ioinvrith this folderfor permit issuance) <br /> Approved By: � <br /> Date: rp� 1 s l Will be Issued separately(separate Green polder,PW issued ahead ofeidg) <br /> ubiic Works has.no scope on this permit---PW Not Required <br /> FLED-TRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: pate: Completed By: Date: �0 <br /> ZQ <br />