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G� <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONL V) PERMIT# '/ V <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 0913 <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre•Insp) Overlay/Agreement N p,ne <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use SVA s or. tor(- <br /> Number of Stories Proposed No,of Dwelling Units: O <br /> Basement ❑No 101yes, Fin/Unfin Total No,of Dwelling Units: Z <br /> Type of Construction Planning/Landscape Inspection Required before Final? []Yes ph4o <br /> Occupancy Group - "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? UNo ❑Yes ❑Shell Only Calculated: Credit: D'S <br /> Code Year OA21 ❑2018. 112015 P9 Everett School Dist ❑Mukjlteo School ist <br /> Fire Sprinklers: ❑Update Existing ❑New System P Not Req'd Park impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: El Update Existing ❑New System ONot Req'd Fee Schedule Used For Calculation(Year): �j 1A <br /> Reason Fire Alarm Required: f^ �♦�� �'^---~�•--- i_M^�� <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes P_No <br /> Add'I RCW 64.55 does required prior to final? []Yes WNo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By- v Date: 5 30 2S" <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review 6 WorksheetNeeded If: <br /> []Sys Dev Eval: <br /> Additional Notes: <br /> ❑Water []Sewer []Storm <br /> i []Traffic Mitigation Eval <br /> Approved By: Date: Mite Work/Drainage(shovm/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> El 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: ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit Issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> WPublic Works has no scope on this permit---PW Not Required <br /> ELECTRICALIPL:UMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: 2MMMAII LLVykVn Date: d(p Za ZeZ <br />