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Intake & Approval Sheet (FOR PERMIT STAFF ONL 9 PERMIT# 82 , " 3 0-7�' <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 2 <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement e-� <br /> Bldg/Tl/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct. Size U Residential Use <br /> Number of Stories Z Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? -UYes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount <br /> Occupancy Load School Impact Fee: Total — <br /> Cert.of Occpuancy Required? ❑No ❑Yes ❑Shell Only Calculated: //2 /— Credit: <br /> — <br /> Code Year ❑2021 0201& 02015 ❑Everett School Dist 'OMukilteo School Dist <br /> Fire Sprinklers: El Update Existing ❑New System Not Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total J %lam (net due afrer credit for existing uses) <br /> Fire Alarm: [:]Update Existing ❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year): —ZG Z 3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1 No <br /> Add]RCW 64.55 docs required prior to final? ❑Yes QNo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> JINAeh ' Ovv h n� 200H SF Xt l 6G=333,494 Approved By: ��!�f�— Date: L <br /> GaragE ftc,5P <br /> (uvcrcd parch 24SF �� 6 = 1,536 <br /> �,8t�ildin� rGv�eWer }d veriC� g PUBLIC WORKS <br /> 3(ub, 9 <br /> Intake OK b Date: <br /> Intake Comments: PW Review&Worksheet Needed if.- " <br /> '19Sys Dev Eval: <br /> Additional Notes: w ElWater ElSewer tgStorm <br /> Q <br /> �Gu , ,/ � Traffic Mitigation Eval <br /> Approved By: Date: h 1, w7 tjje Site Work/Drainage(shovm/triggered) <br /> y Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> 1Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> (hospital,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Fees:Dept. ! ' ) <br /> p �A Separate PW Permit is Required(Permit#: PW � - ,_i'� <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> 54-Minimal or No Fire Scope-NO FIRE FEE MIS located in this folder <br /> ❑Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join vrith this folderfor permitissuance) <br /> Approved By: Date: ❑ 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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />