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Intake & Approval Sheet (FOR PERMIT STAFF ONLN9 PERMIT# 8 �- I 3-0� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> zone -7 17 <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre•Insp) Overlay/Agreement - <br /> Bldg/TI/Addn/Rem Size 0 0 � Nonresidential Use <br /> Garage/Accessory Struct. Size d,T je Residential Use <br /> Number of Stories Z Proposed No,of Dwelling Units: <br /> Basement No ❑Yes, Fln/Unfin Total No.of Dwelling Units: / <br /> Type of Construction Planning/Landscape Inspection Required before Final? RYes []No <br /> Occupancy Group "In Lieu"Fee:Type: - Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cart.of Oce uancy Required? ❑No Wes ❑Shell Only Calculated: //.) / — Credit• —f�— <br /> Code Year 1:12021 E92018. 112015 []Everett School Dist VIMukliteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New SystamEp Not Re(I'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total / of due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing El Now System 13Not Req'd Fee Schedule Used For Calculation(Year): U r/ <br /> Reason Fire Alarm Required: tc-� <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EINO Additional N tes: L/.�-e �/4�"•� /'� -S ' <br /> VALUATION CALCULATION: Total$ 1y 6,,-r 234 <br /> '134,1ty, DWtllin� 2oDgSF xfl4f,:333,494- Approved By: - c ate: <br /> yaragt 4055F ,cfbf. � <br /> t trvcr col p orr>41 24 S F b�" I' PUBLIC WORKS <br /> fi•P,t,�ttlin� rtvrtwer }o ver�Gt .� � <br /> Intake OK by: Date: <br /> flu dl-,e�.j r cal c Intake Comments: / PW Review&Worksheet Needed if: <br /> S c av►�cam{ • OSys Dev Eval: <br /> v � �U-l� <br /> Additional Notes: 6 QC�i/l J<<�uus �Waler �Sewor Storm <br /> (llC!r({Cs��j u Gl�if raffic Mitigation Eval / <br /> r <br /> Approved By: Date: Silo Work/Drainage(shovm/Iriggered) <br /> / ddress Letter <br /> FIRE DEPARTMENT ❑eackflow Prevention for high hazard: <br /> eparate!Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> Fire Sprinklers ❑Fire Alarm ❑Other: <br /> dditional Notes: his Permit Is Approved by Public Works <br /> iSee PW Review Worksheet and associated attached Items <br /> Fire Dept.Fees: A Separate PW Permit Is Required(Permit M PW-1A 0•;3 -d2lb <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> t&Minlinal or No Fire Scope-NO FIRE FEE Is located In this folder <br /> d Review/Inspection Scope-ADD FIRE FEE CIS in a Separate Green Folder Qoln wits,this folderfor permitlssuance) <br /> Approved By: Y1 Date: - C ❑WIII be issued separately(Separate Green colder,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: Z / <br />