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Intake $ Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# 6 2 1 —O S Z- <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 Re uired(Pre-Insp) Overlay/Agreement <br /> Bldg/T11Addn/Rem Size t9 u Nonresidential Use <br /> Garage/Accessory Slruct.Size b 3 Residential Use ` <br /> Number of Stories 21 Proposed No.of Dwelling Units: <br /> Basement fANo []Yes, Fln/Unfin Total No,of Dwelling Units: <br /> Type of Construction PlanninglLandscape Inspection Required before Final? ❑Yes []No <br /> Occupancy Group "In Lieu"Fee:Type: Amount / <br /> Occupancy Load Q, School Impact Fee: Total $ <br /> Cart.of Occpuancy Required? ❑No @Yes []Shell On! Calculated: Credit: <br /> Code Year ❑2021 2018. 112015 ❑Everett School Dist ,WMukiltoo School Dist <br /> Fire Sprinklers: []Update Existing ❑New System Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): —2 0 2 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes }No <br /> Addl RCW 64.55 docs required prior to gnat? ❑Yes MNo Additional Notes: G/�� S G✓��" �'` <br /> VALUATION CALCULATION: Total$ <br /> '11�e.leh ' DWfllin. 2009SF xfl G--333,4`+ Approved By: "t Date: /� <br /> Garage 4o5SP xt 25,912ID <br /> cuvr;r cal porch 24 S F 451� PUBLIC WORKS <br /> figt,;ldir+� rt:viewe� }n veriGt Z(00,160 <br /> Intake OK by: Date: <br /> Intake Comment . PW Review&Worksheet Needed If.• <br /> Y Y� S s b&v Fee -(Zy .Sys Dev Eval: <br /> Additional Notes: G4 u h d wry GQ Water FgSewor storm <br /> )Iq a-lu r <br /> u-fit der Traffic Mitigation Eval <br /> Approved By: _ Date: Site Work/Drainage(shovmltriggered) <br /> Address Letter <br /> FIRE DEPARTMENT ❑Backt]ow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospi(al,supportive houshig) <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: I(A Separate PW Permit Is Required(PermitM PW_S6�1-0.3 <br /> El Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> YJ Minimal or No Fire Scope-NO FIRE FEE LAxis located In tills folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is In a Separate Green Folder Qoln whh this fotderfor permit issuance) <br /> Approved By: Date: ❑WIII be Issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> ❑ Public Works has no scope on this permit---PW Not Required <br /> ELECTRICALiPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: G'S- COL <br />