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00 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONL N9 PERMIT 4 Z 3 OR <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 /> J <br /> Bldg[fl/Addn/Rem Size Z'x' Nonresidential Use <br /> Garage/Accessory Struct.Size <br /> o^S Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement EANo ❑Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Z Planning/Landscape Inspection Required before Final? Byes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Oce uancy Required? []No EAYes ❑Shell OnIL Calculated: //�7 / Credit: <br /> Code Year ❑2021 Q2018. 112015 ❑Everett School Dist WMukllteo School Dist <br /> Fire Sprinklers: ❑Update Existing ew system Not Re<)'d Park Impact Fees for permits applied for after V112022: <br /> Reason Sprinklers Required: N Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: ❑Update ExistingtoNewSystern Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: "J <br /> RCW 64.55 MF worksheet req'd for permit? []Yes No <br /> Add'I RCW 64.55 docs required prior to final? []Yes E]No Additional Notes: GJ Ic $ ' <br /> VALUATION CALCULATION: Total$ V <br /> 0vVtjlin5 2009SF A#14t-333,414- Approved By: Date: <br /> LI arag t 40 5 s F <br /> (t,vWr<iI porch 24 S F A b'�` -^ PUBLIC WORKS <br /> 3100,q 50 <br /> fi. ItiltWte }o vtA A�. Intake OK hy:� Date: <br /> Intake Comments: <br /> pW Rev/ew&Worksheet Needed if: <br /> s P8 v !L G S r Sys D ev Eval: <br /> Additional Notes: <br /> /'etc ti1G6 �,'1Gf� S OWater gsewor Pstorm <br /> Traffic Mitigation Eval <br /> Approved By: Date: ` ' Site Work/Drainage(shovmAriggered) <br /> Address Letter <br /> FIRE DEPARTMENT ❑Backnow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate/Deferred Submittals Required: hospital,supportive housing) <br /> ❑Flre 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: f]A Separate PW Permit is Required(Permit ll:PW 'L 40�'UNfa' <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 M Is in a Separate Green Folder coin wilh this foidorfor permit issuance) <br /> Approved By: Date: ZZI ❑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 /> ELEGTRICAI IPI:UMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: U <br />