Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1c 3-0(?' <br /> BUILDING 11111 •NNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone S <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use 0-(1 j <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size J/ J'03 Asir _ Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size /v/A Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories 1 "In Lieu"Fee:Type: Amount$ <br /> Basement INo ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction I IS Calculated: Credit: <br /> Occupancy Group M ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load )Z7 Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: alpdate Existing ❑New System ❑Not Req'd Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Reason Sprinkles Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: DUpdate Existing :New System ONot 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 IN No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes iikiNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$Z.D XV,00 Additional Note <br /> ff l�n fiP, '212J12-- <br /> Approved By: Date: <br /> PUBLIC WORKS . : <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> /"C 4 4 ❑Sys Dev Eval(uti(/SW)OTraffic Mit Eval <br /> Approved By Date:e, o. Qg V-S�� -4 c1 OSite Work/Drainage DAddress Letter <br /> J ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> •FIRE DEPARTMENT ' supportive housing) <br /> Separate/Deferred Submittals Required: ❑Route this folder for PW Review at end --PW Review Worksheet <br /> Fire Sprinklers tiFire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <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 ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> 4a Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:,V-)l;o<`.vi\ Date: 3,,1 .23 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> i <br /> P • Public Works has no scope---PW Not Required <br /> EL.DCTRICALIRLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: 71C—Z-- Date: %1(0( 2?3 <br />