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111WJ[M c cAppKUV/d/ .fieeE (rt.rt 1`I151v111 a/,1-#rr UIVL T) YI~tNMll F_ q30 042. <br /> BUILDING • <br /> Intake OK by: Date: Intake OK b : •NNING <br /> y y Assign To, Date: <br /> Intake Comments: Intake Comments: • <br /> ll n1. 7Vove tp9- perrmii Igg9 <br /> Zone <br /> Overlay/Agreement 1,; O <br /> El Route to Commercial Building Nonresidential Use Q 1 ti.Y <br /> a Route to Residential Building Residential Use <br /> Make this a"W"Permit Proposed No.of Dwelling Units: <br /> BIdgIT1/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? !Des CINo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ONo DYes, Fin/Unfin School Impact Fee: Total $ / <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group 0Everett School Dist DMukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after'i/1/2022: <br /> Fire Sprinklers: Update Existing ONew System ❑NotReq`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: El Update Existing DNew System ONot 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 /> ROW 64.55 MF worksheet req'd for permit? Dyes 0 No El 50%Credit Issued 0/3/2022-6/2/2023 <br /> Add'I RCW 64.55 does required prior to final? DYes EINo El 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$1/00O.00 Additional Notes: <br /> oi, 51017,2) <br /> pproved By: Date: <br /> PUBLIC WoRKs • • • • <br /> Additional Notes: Intake OK by: Date: 6 610 2 52)3 <br /> Intake Comments: PW Worksheet Needed lf• <br /> pays Day Eval(Utii/sw)[(Traffic Mit Eval <br /> Approved Bay ✓!r/, Date:ayli*' g ❑Site Work/Drainage [(Address Letter <br /> / DBackflow 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 OFire Alarm DOther: EIThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND 0Create Green Folder OSubmitted Previously 0Deferred <br /> 0 This Permit is Approved by Public Works <br /> Fire Dept.Fees: 0 See PW Review Worksheet and associated attached items <br /> El Review of As-Built Plans-NO FIRE FEE El A Separate PW Permit is Required(Permit#: PW ) <br /> El Minimal or No Fire Scope•-NO FIRE FEE AND ❑ Is located in this folder <br /> 0 Review!Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this foiderfor permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope—•-PW Not Required <br /> PI..1~CTRICAItIP•.I.U1111BING <br /> Additional Notes: <br /> Additional Notes: S <br /> Approved By: Date: Completed By: Date: 0 11 1 d� 7/Zj <br />