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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 131"3-0-7 1 <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre•Insp) Overlay/Agreement <br /> Bldgfrl/Addn/Rem Size ?i0 U Nonresidential Use <br /> Garage/Accessory Struct.Size �� Residential Use <br /> Number of Stories Z Proposed No.of Dwelling Units: <br /> Basement [%No ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Tye of Construction 1Z9 Q Planning/Landscape Inspection Required before Final? W-Yes []No <br /> Occupancy Group - ' "In Lieu"Fee:Type: 7 Amount$ <br /> Occu ancy Load School Impact Fee: Total $ ZL2T <br /> Cart,of Occpuancy Required? []No es ❑Shell Only Calculated: /-2 / Credit: ~— <br /> Code Year ❑2021 N2018. 112015 ❑Everett School Dist j2WuklIt90 School Dist <br /> Fire Sprinklers: []Update Existing ❑New System t Not Req'd Park impact Fees for permits appi d for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due aftt7ercrodlt forexlslIng uses) <br /> Fire Alarm: ❑Update Existing ❑New System Qrlot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF%vorksheet req'd for permit? ❑Yes M No <br /> Add'I RCW 64.55 does required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ 361 <br /> `J- t,leh" " 0Wtjlin5 2009SF xf146 rzl <br /> Approved By: i� Date:garagt 4v55F xf <br /> M(W c d p orcH 24 S F 44 ` ____, PUBLIC WORKS <br /> fi.gtl�l�lnc� r�Vit.Wtf }o Vtl�� � 3lob��5� � <br /> Intake OK by: Data: <br /> Intake Comments:j� / PW Review&Worksheet Needed If. ^Y s �e l pZL S ��Y ys Dev Eval: <br /> Additional Notes: YaGt`�d 51 � S Owater `[Sewer Storm <br /> 9rJClud ld raffle Mitigation Eval <br /> Approved By: Date: �t v �2 3j&9'�1 Site Work/Drainage(shovmhriggered) <br /> Address Letter <br /> FIRE DEPARTMENT ❑Backilow Prevention for high hazard: <br /> VSerate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> p q <br /> Fire Sprinklers ❑Fire Alarm ❑Other: hospital,supportive housing) <br /> ddi Tonal 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��U3 <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 Qoinw th this fo►dor for permit issuance) <br /> P P <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/PL:UMBING AArtitlnnal Notes: <br /> Additional Notes: <br /> Approved By: Date: Compl Date: 2� <br />