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111LctnC oc'Approva1 J11UW. lrur‘ o 1 Hrr v/vLT) Vtrx1Yl11 _3U1/..., D g <br /> BUILDING " INNING 'T <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> BIdgl l/Addn/Rem Size _ S� 44 Total No. of Dwelling Units: <br /> Garage/Accessory Struct. Size — Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement alNo ❑Yes , Fin/Unfin School Impact Fee: Total $Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits wiled for after 1/112022: <br /> Fire Sprinklers: El Update Existing ❑New System JX1Not'Req'd Park Impact Fee Total$ /// (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): c2-3 <br /> Fire Alarm: DUpdate Existing IXINew System ONot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EA/IC19.53.200 <br /> Reason Fire Alarm Required: > 3daU 4.►-'- El 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? Oyes Et No 91, 50%Credit-Issued 9/3/2022-6/2/2023 r p 1.," f\ <br /> Addi ROW 64.55 does required prior to final? ❑Yes ©No ❑ 0%Credit Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ e;eb Additional Notes: A/0 f� Ge h lj- 4', 1G/q I/ ' <br /> • /3c� • lf' • 9' <br /> Approved By: Date: 3_ 2_5 <br /> PUBLIC WORKS - . . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> ❑Sys Dev EvaI(Util(sW) ❑Traffic Mit Eval <br /> Approved By: e7 Date: 41Q.tor?�t.3 DSite 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 <br /> ,,Submittals Required: ❑Route this folder for PW Review at end --PW Review Worksheet <br /> ❑Fire Sprinklers JLrt-ire Alarm DOther: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND DCreate Green Folder ❑Submitted Previously ❑Deferred <br /> VI.This Permit is Approved by Public Works <br /> Fire Dept.Fees: Vl 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 /> .Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By:y; )cb(,U A Date: 9 �3 ❑Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/.PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed i3y:,.+71 lM a,641461'I, NI Date: 5 (q J 245 2,2, <br />