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!Matte doApproval kneel (runt',crctvU1 a1Art- UIVR.Y) PERMIT/ i3A20 r .., 0 9,5 <br /> BUILDING . "NNING <br /> Intake OK by; /k-A-- Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <br /> Zone M J <br /> atcRoute to Commercial Building Nonresidential Use <br /> ❑Route to Residential Building Residential Use <br /> Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bidg/TI/Addn/Rem Size /j Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? DYes IlNo <br /> Number of Stories / "In Lieu"Fee:Type: Amount$ <br /> Basement Piro5No C(Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction fl/ .* Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist DMukilteo School Dist <br /> Occupancy Load n J Park Impact Fees for permits applied for after 1/112022; <br /> Fire Sprinklers: OUpdate Existing :New System otReq`d Park Impact Fee Total$ (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: OUpdate Existing :New System lsiot Req`d Permit Technician Use Only:Apply Phase-In Credit Per EMCi9.53.200 <br /> Reason Fire Alarm Required: 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'l ROW 64.55 docs required prior to final? 0Yes No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ c 25 O' Additional Notes: <br /> Approved By:' {J. `" C.s Date: 28 i Qv 1 2023 <br /> P•UBI_IC WORKS •• . <br /> • <br /> Additional Notes: e-iii-Jlyy c-d'r1s 45,j Intake OK by: Date: <br /> �� Intake Comments: PW Worksheet Needed If: <br /> ?Li 1 ❑Sys Day Eval(Util/sW)❑Traffic Mit Eval <br /> Approved By: / C Date:5 /?/�3 Mite Work/Drainage DAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTNI)NT . - supportive housing) <br /> Separate/Deferred Submittals Required: DRoute this folder for PW Review at end --PW Review Worksheet <br /> Fire Sprinklers DFire Alarm Other: EIThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate Green Folder OSubmitted Previously QDeferred <br /> 0 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 0 A Separate PW Permit is Required(Permit#:PW ) <br /> Q Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> 0 Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: j(\ Date: 41 .9 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> blic Works has no scope—PW Not Required <br /> ELECT.R(CALJELUNIBING . Additional Notes: civ//-,,,,bbr <br /> Additional Notes: �': �v� <br /> Approved By: Date: Completed By: Date: 4/016 ez3 <br />