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Intake&Approval Sheet (Fir^ PERMIT STAFF onY) PEP"IT#�-�L-rl <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:�_ Assign To: J 2,SS Date: 3 1 1 Z� <br /> intake Comments: Intake Comments: <br /> Zone <br /> ❑Make this a"W"Permit ❑ SRC Required(Pre-]nap) OverlaylAgreement Y— <br /> BidglTl/AddnlRem Size Nonresidential Use _— <br /> Garage/Accessory Struct.Size -So Residential Use F�� <br /> Number of Stories Proposed No.of Dwelling Units: <br /> Basement Q'No [yes, Fin 1 Unfin Total No.of Dwelling Units: <br /> Type of Construction PlanninglLandscape Inspection Required before Final? QYes ERNo <br /> Occupancy Group r "In Lieu"Fee:Type: Amount$O <br /> Occupancy Load School Impact Fee; Total $2 <br /> Cert,of Occppancy Required? 5NO QYes ❑Shell Only Calculated: Credit: <br /> Code Year FA2021 Q2018 02015 ❑Everett School Dist QMukiltec School Dist <br /> Fire Sprinklers: 0-Update Existing QNew System ®Not Req'd Park Impact Fees for permits applied for after 111/2022: <br /> Reason Sprinklers Required: Park impact Fee Total$ (net due after credit forexlsfing uses) <br /> Fire Alarm: El Update Existing QNew System QNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: ......... ._,-, .., ...... <br /> RCW 64.55 MF worksheet req`d for permit? ayes 1�1 No <br /> Addl RCW.64.55 docs required prior to final? E]Yes QNo Additional Notes: <br /> VALUATION CALCULATION: Total <br /> Approved By. , Date;3I11 Zy <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: AWRevlew&.WorksheefNeededif- <br /> ys Dev Eval: ` <br /> Additional Notes: p LSO -r/i nG <br /> El <br /> �,,� Water Clsewer Storm <br /> u ""ElTraffic Mitigation Eval <br /> Approved By: (, Date: Kill �1+t �.�T,l x,Ph�,e ElSite WorklDrainage(shownitriggered) <br /> �+�/Gk, 'QAddress Letter <br /> FIDE DEPARTM1=iVT ;ElBacktlow Prevention for high hazard: <br /> i <br /> Separate 1 Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospltal,supportive housing) <br /> ❑Fire Sprinklers ❑Fire Alarm QOther: E <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#.PW <br /> Q Review of As-Built Plans-NO FIRE FEE: AND Q Is fully digital <br /> 21 Minimal or No Fire Scope-NO FIRE FEE IS located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE Q Is in a Separate Green Folder aornw;th this fotderfor permit issuance) <br /> Approved By.7 Date; Will be issued separately(Separate Green Rider,PW issued ahead of Bldg) <br /> Q Public Works has.no scope on this permit---PW Not Required <br /> ELECTRICALIPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: ate: p Li pi ZaZ <br />