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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# v2— ► "3 —079l <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 (Pro•Insp) Overlay/Agreement <br /> Bidg/TI/Addn/Rem Size -Lo 0 Nonresidential Use <br /> Garage/Accessory Struct. Size 0 Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement QL41,1No ❑Yes, Fin/UnM Total No.of Dwelling Units: / <br /> Type of Construction Z 2 Planning/Landscape Inspection Required before Final? es []No <br /> Occupancy Group `r "In Lieu"Fee:Type: `- Amount$ <br /> Occupancy Load School Impact Fee: Total $ / <br /> Cart.of Occpuancy Required? ❑No RYes []Shell Only Calculated: �2 / rr--r��� Credit: <br /> Code Year ❑2021 M018. 2015 ❑Everett School Dist LdMukliteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System EpNot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total /(not due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing []Now System Mot Req'd Fee Schedule Used For Calculation(Year) lJ L <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? []Yes No <br /> Add'I RCW 64.55 docs re utrod prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ tj�� r� �v ��6�• <br /> ovvfllin, 2009 SF xf1 =333141+ Approved By: <br /> yPrgt +06SIP x 25112a <br /> (bvcr(d porch USF �� {�536 PUBLIC WORKS <br /> fi.t3t��ldinc� rGvrtwer }o vcrit;t $ 360,I50 <br /> � Intake OK by: Date: _ <br /> Intake Comments: U PW Review&Workshoet Needed if: <br /> 5/,fCj ��✓ �e�� (' 1�1$ys ev Eval: <br /> Additional Notes: c n0ao�j S1L0-fZ�Lr�S Water C`Sewor Storm <br /> tito <br /> raffle Mitigation Eval <br /> Approved By: Date: Y) Work/Drainage(shown/triggered) <br /> pa ���//�l Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> S arate/Doferred Submittals Re uired: (dental,medical,animals,mortuary, <br /> q hospital,supportive housing) <br /> Ire 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 Dept.Fees: =A Separate PW Permit Is Required(Permit#:PW2 U - ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> RMInImal or No Fire Scope-NO FIRE FEE 'M Is located In this folder <br /> ❑Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(tom with tilts folder for permit Issuance) <br /> Approved By: Date: ,1 Cl_ L ❑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 /> ELECTRICALiPL:UMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed BE.::L50" Date: <br />