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Intake & Approval Sheet OR PERMIT STAFF ONLY) �RMIT# S6004---Ose7 <br />13UILDING <br />intake OK by: Date: <br />intake Comments; <br />❑ Make this a "W" Permit <br />❑ 5RC Required (Pre -I ep) <br />BldglTI/Addn/Rem Size <br />lye r <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />LIo ❑Yes , Fin I Unfln <br />Type of Construction <br />Occupancy Group <br />1 <br />Occupancy Load <br />Cert. of Occppancy Required? <br />Wo flyes QShell Only <br />Code Year <br />112021 112018 02015 <br />Fire Sprinklers:9-update Existing Mew System []Not Req'd <br />Reason Sprinklers Required:� <br />Fire Alarm: Update Existing ❑New System ElNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? []Yes No <br />r��r <br />Add'IRCW..64.55docsrequired prior tofinal? ElYes 1.allo <br />VALUATION CALCULATION: Total $ OJ 40 <br />Additional Notes: <br />Approved By; Date:DZy <br />Fll E DEPARTNIM; <br />Separate I Deferred Submittals Required: <br />Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />El Review of As -Built Plans- NO FIRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />El Review inspection Scope -ADD FIRE FEE <br />Approved By: 407-j. Date: T11z6 LA <br />ELEGT.RICALIPLUM BIN G <br />Additional Notes: <br />Approved By: Date: <br />PLHIVIYIN�Y <br />Intake OK by: Assign To: e-SS Date: 3 ZO Zci <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />A VA A C P: <br />NonresidentialUse <br />Residential Use <br />�— <br />Proposed No. of Dwelling Units: <br />Total No, of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes INNo <br />"in Lieu" Fee: Type: Amount $ D <br />SchoollmpactFee: Total $. 6 <br />Calculated: Credit: <br />DEverett School Dist ❑Mukiltee School Dist <br />Park Impact Fees for permits applied for after 11112022, <br />Park Impact Fee Total $ D (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date:3 /2p�2 <br />PUS.LIC W®RK5 <br />Intake OKby:. Date_; _ <br />Intake Comments;PWleviexr & WorksheefNeededif W <br />,j [1Sys Dsv Eval : <br />I UWater USewer E]Stonn <br />1QTraftic Mitigation Eval, <br />E[ISite WorklDrainage (shown/triggered) <br />iElAddress Letter <br />ju sackHow 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 />El ASeparate PW Permit is Required (Permit#: PW ) <br />AND ❑ is fully digital <br />p Is located in this folder <br />El -t Is in a Separate Green Folder Qoinwiththtsfolderforpermit Issuance) <br />EjWII1 be issued Separately (separate Green Folder, PW issued ahead of Bldg) <br />bkPublic Works has -no scope on this permit--- PW Not Required <br />Additional Notes: <br />Completed B Date: 7� <br />uJ <br />