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Intake $ Approval Sheet (FOR PERMIT STAFF ONLY PERMIT # 6 2 1 " — O S Z- <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Re uired (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />t9 u <br />Garage/Accessory Slruct. Size <br />b 3 <br />Number of Stories <br />21 <br />Basement <br />11No []Yes, Fin / Unfin <br />Type of Construction <br />Occupancy Group, <br />Occupancy Load <br />Q% <br />Cart. of Occpuancy Required? <br />❑No @Yes []Shell Onl <br />Code Year <br />❑2021 2018. 112015 <br />Fire Sprinklers: []Update Existing ❑New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System gNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF Worksheet req'd for permit? ❑Yes} No <br />Add'I RCW 64.55 docs required rlor to final? ❑Yes QNo <br />VALUATION CALCULATION: Total $ <br />OWf tin' 2009SF xf1 f. 333,494 <br />Garage +065F Xf 25,12ID <br />(bftf(A porch 24SF e44516 <br />) g&A"Jdmj t•tvrtwtr }n V l j alo(7, 160� <br />Additional Notes: <br />Approved By: _ Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />,s❑ Review of As-Bullt Plans - NO FIRE FEE <br />YJ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope -ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICALiPLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No, of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes []No <br />"In Lieu" Fee: Type: ^— Amount / <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ,WMukiltoo School Dist <br />Park Impact Fees for perm�iitts applied for after 111/2022: <br />Park Impact Fee Total /— (net due alter credit for exfsthig uses) <br />Fee Schedule Used For Calculation (Year): —2 0 2 <br />Additional Notes: " <br />Approved By: "t— Date: <br />PUBLIC WORKS <br />Intake Ott by: Date: <br />Intake Comment . PW Review & Worksheet Needed If.• ' - <br />S yS be -(I Fee -(ZY *ys Dev Eval : <br />c� rou d vwr% Water PSewor VStorm <br />tC,o dam-Zile <br />Traffic Mitigation Eval <br />Work/Drainage (shovm/triggered) <br />Address Letter <br />❑Backfiow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospi(al, supportive housing) <br />This Permit Is Approved by Public Works <br />See PW Review Worksheet and associated attached Items <br />I(A Separate PW Permit Is Required (PermitM PW-S6�1-0.3 <br />AND ❑ Is fully digital <br />LAxis located In tills folder <br />❑ Is In a Separate Green Folder Qoln with this folder for permit issuance) <br />❑ 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 />Additional Notes: <br />Completed By: Date: 4!��S"72 <br />