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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# alv-3 O s —0 76 <br /> BUILDING i l NNING <br /> Intake OK by: Date: Intake OK by: Ij M Assign To: iM Date: (p "21-L3 <br /> Intake Comments: Intake Comments: <br /> Zone C,-1 <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use y e-S <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: fi p <br /> Bidg/TI/Addn/Rem Size 14 '?' Total No.of Dwelling Units: 1 <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes giNo <br /> Number of Stories I) "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction 1 e-Ct Calculated: Credit: <br /> Occupancy Group I R-t- El Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 1 1R.Je--• Park Impact Fees for permits applied for after'IM/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd Park Impact Fee Total$ p (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19,53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add]ROW 64.55 docs required prior to final? ❑Yes ❑No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 15a, Additional Notes: No ex fwllS i OA b e y o,r�dl eXtc 1604()Atli <br /> Approved By: - /f _ _ ,/ Date: 6.z/_Z3 <br /> PUBLIC WORKS . . .. <br /> Additional Notes: "1F2� Va{kN4,gt,1ic. ti,&( at.-, Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed/ <br /> ❑Sys Dev Eval(util/sW))]Traffic Mit Eval <br /> Approved By: Date: (p(x,3 ` ❑Site Work/Drainage DAddress Letter <br /> ft,_,T--6 <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> •FIRE DEPARTMENT • supportive housing) <br /> Separate/Deferred Submittals Required: El Route this folder for PW Review at end —PW Review Worksheet <br /> ❑Fire Sprinklers ❑Fire Alarm El Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> This Permit is Approved by Public Works <br /> Fire Dept.Fees: ❑ See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#:,PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> ElReview/Inspection Scope-ADD FIRE FEE 0 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 /> 0 Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: Y‘0 <br /> Approved By: Date: Completed By: akvi'hnjDate:0 5 130'Z022 <br />