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Intake &Approval Sheet •OR PERMIT STAFF ONLY) PERMIT# A3 Qq—Q - <br /> BUILDING I •NNING <br /> � <br /> intake OK by: Date: Intake OK by: Assign To:4 1A Date: It)1211, <br /> Intake Comments: Intake Comments: <br /> Zone R-3- <br /> Overlay/Agreement <br /> 0 Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use `14 , SFR <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? QYes 121No <br /> Number of Stories 1 "In Lieu"Fee:Type: Amount$ <br /> Basement t►'No QYes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction L Calculated: Credit: <br /> Occupancy Group =Q.C- DEverett School Dist ®Mukilteo School Dist <br /> Occupancy Load T" — Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers:OUpdate Existing ONew System Iot.Req'd Park Impact Fee Total$ 11 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ONew System &lot 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? QYes g'No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I ROW 64.55 dots required prior to final? ❑Yes s No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ S o AdditionaI Notes: <br /> Approved By: 7e—ii. fj f/' Date: 40- <br /> P•Ulkle WORKS ' <br /> Additional Notes: Intake OK by: Date: <br /> iy1rGK {.NO el.-c. O5E0 (oRL-M (- M.-- Intake Comments: PW Worksheet Needed If: <br /> co+)L°t' OSys Dev Eval(Utif/SW)DTraffic Mit Eval <br /> Approved By: tut t Date: L}1 I t(.7,07,3 Mite Work/Drainage DAddress Letter <br /> ❑iBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> •FIRE DEPARTMENT ' . supportive housing) <br /> Separate!Deferred Submittals Required: DRoute this folder for PW Review at end --PW Review Worksheet <br /> ❑Fire Sprinklers DFiire Alarm Other: E1This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> El This Permit is Approved by Public Works <br /> Fire Dept.Fees: 0 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 /> El 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 folderfor permit issuance) <br /> Approved By: Date: El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> VI Public Works has no scope--PW Not Required <br /> EI...ECT.RICALIRLUl11IBING . Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:iWkit <br /> ANAMAtAmy Date: 04101 JU/3 <br />