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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 132- ftZ-C1 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 2 Z, <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre•Insp) Overlay/Agreement <br /> Bldg/TI/Addn/Rem Size ?S Nonresidential Use i✓ <br /> Garage/Accessory Struct.Size Z Residential Use <br /> Number of Stories 7, Proposed No.of Dwelling Units: <br /> Basement 1ANo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction 2 Z Planning/Landscape Inspection Required before Final? ff.yes ❑No <br /> Occupancy Group `/ "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load `) School Impact Fee: Total $ /42/ — <br /> Cert,of Occpuancy Required? ❑No MYes []Shell Only Calculated: Credit: I------ — <br /> Code Year 102021 Q2018. P2015 ❑Everett School Dist ukilteo School Dist <br /> Fire Sprinklers: []Update Existing❑New system Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total 3 (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd Fee Schedule Used For Calculation(Year): <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? []Ye,; 15No Additional N tes: <br /> VALUATION CALCULATION: Total$ 7_ �1��, �i)rl'!' ,�c 6%e) �& <br /> mt IsertV100�i " Wp kj'Ihq jgr( SF x f 166'312,24b Approved By: �_�� ate: <br /> V <br /> A Ll e, •/ i If S r x4(o+'- '",13fp <br /> toVcrcd porrOrl 9-1 SF X46f% 2�bt� PUBLIC WORKS <br /> gtn�ldin9 re��wau ro"tn J $s4z,006 Intake OK by` Date: _ <br /> Intake Comments:L�/ PIN Review d Worksheet Needed Ik <br /> Jcr S �e v I z ' rl Sys Dev Eval <br /> Additional Notes: ( �,�l Ct AS J� �f���5 Water f�sewer Storm <br /> ( I �-�f' MTraffic Mitigation Eval <br /> Approved By: Date: Lo Z�D 7j 0(5 Site Work/Drainage(shown/triggered) <br /> Address Letter <br /> FIRE DEPARTMENT ❑Backiiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Se <br /> p q hospital,supportive housing) <br /> Fire Sprinklers El Fire Alarm ❑Other: <br /> Additional Notes: This Permit is Approved by Public Works <br /> 19-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 yyyIs 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 Qoin with this folder for permit issuance) <br /> Approved By:K , Date: — ❑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 /> ELECTRICAUPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: r Date: 6 <br />