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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# E.a,3o 4 -031 <br /> BUILDING •i *INNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone MU <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use t;j lk(-jxtrta It). <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TUAddn/Rem Size 10 --4° Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size — PIanning/Landscape Inspection Required before Final? CIYes CINo <br /> Number of Stories 1=7-7 "In Lieu"Fee:Type: Amount$ <br /> Basement K1 No ❑Yes, Fin/Unfin School Impact Fee: Total $ ,----- <br /> Type of Construction �-r S• Calculated: Credit: <br /> Occupancy Group R-- Z. ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load — Park Impact Fees for permits applied for after 1/1I2022: <br /> Fire Sprinklers:IXIUpdate Existing ONew System ElNot Req'd Park Impact Fee Total$ / (net due after credit for existing uses) <br /> Reason Sprinklersry Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm:, C-tUpdate Existing ONew System El Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: El Yes t El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet req'd for permit? DYes ,� No ❑ 50%Credit-Issued 0/3/2022-6/2/2023 <br /> Add]RCW 64.55 does required prior to final? ❑Yes EINo El 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 300o Additional Notes: <br /> Cl_QQ 1-i At lz.-; <br /> Approved By: Date: <br /> P•UI31.IC WORKS <br /> Additional Notes: 1m' . . #Z.e-P•a1 R- pate, Intake OK by: Date: <br /> PAvvlekkiC. '5..1‘,..�,ur,i, 'E44v&weE s.ra-r- Intake Comments: PWWorksheet Needed it <br /> T'Pe L,T- O•c= .y440,ps [(Sys Dev Eval(UGIsw) [(Traffic Mit Eval <br /> Approved By: x1=r.,.. Date: 4-/1� [(Site Work/Drainage [(Address Letter <br /> 1 ❑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 ❑Fire Alarm Other: OThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND El Create Green Folder ❑Submitted Previously ❑Deferred <br /> El This Permit is Approved by Public Works <br /> Fire Dept.Fees: El 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 0 Is located in this folder <br /> Review!Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:"1<.i Y..YtJn 4'Date: . ....6v13 ElWill be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> Public Works has no scope--PW Not Required <br /> ELECTRICALIRLUMBING • Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: ] KZ— Date: 4.' 1 oi?,07i 3 <br />