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Intake & Approval Sheet <br />kojto� s bl�-Frlz. <br />APERMIT STAFF ONLI) <br />HPA0 0FZ�� o -vim <br />P IT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />Z <br />Garage/Accessory Struct. Size <br />) <br />Number of Stories <br />3 <br />Basement <br />�j7�� <br />[No DYes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert. ofOccpuancyRequired? <br />[]No Yes ❑Shell Only <br />Code Year <br />❑Sc <br />20 1 Q2018 E12015 <br />Fire Sprinklers: Update Existing IONew System ❑Not Req'd <br />Reason Sprinklers Required: -try S' v 1(S <br />Fire Alarm: ❑Update Existing D New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? DYes El No <br />Add`[ RCW 64.55 does required prior to final? Dyes wo <br />VALUATION CALCULATION: Total <br />t7;t7 it V'616E; <br />�l r x Ou - a6f3oq <br />3 C L( <br />3(s <br />Additional Notes: <br />Approved By:,` Date: kz Zf ris <br />FIRE. DEPARTMENT <br />Separate I Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />Review Inspection Scope -ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />/ <br />Overlay/Agreement <br />Nonresidential Use <br />— <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? Mee []No <br />"In Lieu" Fee: Type: Amount $ �' <br />School Impact Fee: Total $ Cb <br />Calculated: >2/�l—� Credit: �}— <br />❑Everett School Dist MMukiltec School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />i <br />Park Impact Fee Total $���_, (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: Zdr/,%Zy <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PWRevfewB Worksheet Needed if., <br />E[Sys Dev Eval : <br />( ❑Water ElSewer ❑Storm <br />(]Traffic Mitigation Eval <br />Work/Drainage (shown/triggered) <br />tt,[]Site <br />10Address Letter <br />I I]Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />(hospital, supportive housing) <br />This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ ASeparate PW Permit is Required (Permit#: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder Goin vrith this folderfor 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 />11 <br />Completed By: ate: U.J <br />i b 1'2&6Z <br />