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FOR OFFICE USE ONLY <br />BUILDING <br />ddn/Rem Size <br />Bld q* <br />_ t <br />A <br />Garage Size <br />Surcharge <br />VALUATION <br />Proposed No. of Dwelling Units: <br />Water <br />No. of Stories <br />Sewer <br />Phone #: <br />Occupancy Group <br />Yes No <br />Systems Dev. Fees <br />Occupant Load <br />Public Works <br />A <br />Basement <br />Yes <br />No Fin/Unf <br />Type of Construction <br />Exstg Sprinkler System? <br />Yes <br />No Unk <br />Fire S rink Re d? <br />Yes <br />No <br />Reason <br />Exstg Fire Alarm? <br />Yes <br />No Unk <br />Fire Alarm Re d? <br />Yes <br />No <br />Reason <br />Enclosure RC 4.55 <br />Yes <br />No <br />Approved b : <br />Commen <br />=Date - <br />3 - <br />FEES <br />Plan Check Fee <br />_ t <br />Building Permit <br />Date: <br />Surcharge <br />Additional Plan Check <br />Proposed No. of Dwelling Units: <br />Water <br />e or P ing Inspection <br />Landsc:efore <br />need final? Yes No <br />Sewer <br />Phone #: <br />Systems Dev. Due? <br />Yes No <br />Systems Dev. Fees <br />Everett School Dist ilteo School Dist <br />Public Works <br />Calculated S of Impact Fee: <br />Traffic Mitigation Due? <br />Yes No <br />School Mitigation Fee <br />e,t50-7-o(6 <br />PLANNING <br />Zoning Classification <br />_ t <br />Overlay/Agreement <br />Date: <br />Nonresidentiallj_e <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />e or P ing Inspection <br />Landsc:efore <br />need final? Yes No <br />lannin Inspector: <br />Phone #: <br />Approved by: Date -7-+l is <br />Historic Approved by: Date: <br />School Mitigation Re d? Yes N <br />Everett School Dist ilteo School Dist <br /># of Net New Units, <br />Calculated S of Impact Fee: <br />School I act Fee Credit: <br />Total School Impact Fee Owed: <br />Comments: <br />PUBLIC WORKS <br />Review Required? <br />Yes No <br />Reviewer: <br />Date: <br />Comments: <br />