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Intake & Approval Sheet (FOR PERMIT STAFF ON0) PERMIT# " �ko <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone Z77 <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement <br /> nj <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size L Residential Use <br /> Number of Stories L Proposed No.of Dwelling Units: <br /> Basement No ❑Yes , Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction ZAZ L Planning/Landscape Inspection Required before Final? _�es ❑No <br /> Occupancy Group ` / "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load "� School Impact Fee: Total $ / <br /> Cert,of Occpuancy Required? ❑No NYes ❑Shell Only Calculated: /).l / — Credit: --- <br /> Code Year 02021 g2018 ❑2015 ❑Everett School Dist PMukilteo School Dist <br /> Fire Sprinklers: El Update Existing []New System of Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total$35.f2 --(net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System Vllof Req'd Fee Schedule Used For Calculation(Year): p 0.2 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add'I RCW 64.55 does required prior to final? ❑Yes 133NO Additional Notes: <br /> VALUATION CALCULATION: Total$ Z <br /> %I Lmoyi` C)WCIt I hq % � SF x �lt, =311� Approved By: r/L--- Date: <br /> rr11 atra 2 J 4-z4 sr- x��° Z'1'�i <br /> coV red pore► 41 SF n4 �6 ��"� PUBLIC WORKS <br /> V0N11dih9 rcv1wou N vCnb If` $Siz, Intake OK b J _y: �T'c� Date: <br /> Intake Comments: PW Review&Worksheet Needed If. <br /> bl6ys Dev Eval: <br /> Additional Notes: q✓�ud1��(�r��J Water Sewer Storm <br /> Traffic Mitigation Eval <br /> Approved By: Date: �, ��230 7-� Site Work/Drainage(shovm/triggered) <br /> ddress Letter <br /> I. <br /> ❑ <br /> FIRE DEPARTMENT I "7 7�W Backflow Prevention for high hazard: <br /> dental medical animals,mortuary, <br /> Separate 1 Deferred Submittals Required. s <br /> ( or' ( <br /> �P���Z �/ hospital,supportive housing) <br /> ®Fire Sprinklers ❑Fire Alarm ❑Other: , s{/it LGI ����7/� rTIL- <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 ` WVq O�I <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 /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Goln with this folder for permit issuance) <br /> Approved By: Date: - G ❑WIII be issued separately(separate Green Folder,PW Issued ahead of Bldg) <br /> ❑ Public Works has no scope on this permit---PW Not Required <br /> ELECTRICALIPLUMB11 G Additional Notes:Additional Notes: {/ �j/ f' �� ` �_1 <br /> Approved By: Date: 1completed By: Date: L <br />