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Intake & Approval Sheet <br />kVlIWn S- PrfM,2 <br />(110 PERMIT STAFF ONLr <br />Negovitt <br />P IT# �3a30W-Ow <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-insp) <br />BldgrF]/Addn/Rem Size <br />Z <br />GaragelAccessory Struct. Size <br />I <br />Number of Stories <br />3 <br />Basement <br />ICNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />9—C _ <br />Occupancy Load <br />RC <br />Cart. of Occpuancy Required? <br />[]No <br />YYtes ❑Shell Only <br />Code Year <br />[]20 1 <br />c� 2018 112015 <br />Fire Sprinklers: []Update Existing IONew System ❑Not Req'd <br />Reason Sprinklers Required: '�4� <br />S'r V ITS <br />Fire Alarm: ❑Update Existing ONew System EQNot <br />Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? <br />[]Yes El No <br />Add'I RCW 64.55 does required prior to final? <br />[]Yes ONO <br />VALUATION CALCULATION: Total <br />t-7.;t7 (�6 <br />( r >e �u - <br />3 > 6 L( <br />- agG, <br />a6r3oq <br />its o�� <br />Additional Notes: <br />Approved By: Date: (2 Z/ Z <br />FIRE DEPARTMENT <br />Separate / 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 />ELEISTR(CALIPLUM B ING <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 />% <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? Yes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ ERE <br />Calculated: Credit: I] Everett School Dist JAMukiltec School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />i <br />Park Impact Fee Total $U_. (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): a O 2 <br />Additional Notes: <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: <br />Date: <br />Intake Comments: <br />_-� ..... _- ...... .._...... .... <br />PWReview& Worksheet Needed if., <br />OSys Dev Eva[ : <br />OWater ❑Sewer ❑Storm <br />l OTraf is Mitigation Eval <br />jOSite Work/Drainage (shown/triggered) <br />OAddress Letter <br />OBackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />14 This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder Gain with 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 />"1 <br />Completed By: <br />ate: Z <br />Z <br />III <br />