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Intake $ Approval Sheet (FOR PERMIT STAFF ONL r PERMIT# <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 b 0` Nonresidential Use <br /> Garage/Accessory Struct. Size 07� Residential Use <br /> Number of Stories �h v Proposed No,of Dwelling Units: A/ / <br /> Basement MNo ❑Yes, Fin/Unfin Total No,of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? Yes ❑No <br /> Occupancy Group "In Lieu"Fee:Type: Amount$ <br /> Occu ancy Load School Impact Fee: Total $ l / <br /> Cert.of Occ uancy Required? ❑No PYes ❑Shell Only Calculated: 11-2 / Credit: - <br /> Code Year 1112021 K12018. 112015 ❑Everett School Dist ukllteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ .33)1 r(net due aftercradlt for adung uses) <br /> Fire Alarm: ❑Update Existing ❑New System PNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> Add'I RCW 64.55 does required prior to final? ❑Yes 11 No Additional Notes: ftiy( /� CXIA <br /> VALUATION CALCULATION: Total$ <br /> ►)Wtllin' 2009SF xf140 33,41+ pprov y: Date: C <br /> qarayt +055F ,cf�6 25,�2a JtAID <br /> Cuvcr(A p orc l 24 S F rc b�` 1,53 b PUBLIC WORKS oI <br /> fi.gt��ldin� t•Gv�t.we� }n Ve,+iGt 1� � atob,q-- <br /> Intake OK b Date: _ 7/ <br /> Intake Comments. PW Review&Worksheet Needed/h <br /> D.li1/ iCD1-/ ys Dev Eval: <br /> Additional Notes: �,OrN{,(Jf• ro <br /> oaij �art�es �j Water i�Sewor Storm <br /> to de� •1 Traffic Mitigation Eval <br /> Approved 13y: �. Date: I' l Site Work/Drainage(shovmllriggered) <br /> l OAddress Letter <br /> FIRE DEPARTMENT ❑Backfiow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> Se <br /> p q 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 Dept,Fees: A Separate PW Permit Is Required(Permit It:PW Z`�0`l'G' 1.0 ) <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(Join with this folder for permit issuance) <br /> Approve <br /> d 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 B . Date: 3 L <br />