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lnlaKe & Approval sheet (1-UN l'CilV1J 1 �Sl AI=;F 0JVL Y) <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />Q Route to Commercial Building <br />❑ Route to Residential Building <br />Make this a "W" Permit ' <br />Bldg1TllAddn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />5allo []Yes , Fin / Unfin <br />Type of Construction <br />11A <br />Occupancy Group <br />0 A-3B <br />Occupancy Load <br />Fire Sprinklers: []Update Existing ONew System DKNotReq'd <br />Reason Sprinklers Required: <br />Fire Alarm: ®Update Existing LINew System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.56 MF worksheet req'd for permit? []Yes IN No <br />Add'1 RCW 64.55 docs required prior to final? []Yes 2No <br />VALUATION CALCULATION: Total $1 ! J110. 00 <br />Additional Notes: <br />Approved ByDate. <br />FIRE DEPARTMW <br />Separate Deferred Submittals Required: <br />[]Fire Sprinklers DFire Alarm []Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />[] Minimal or No Fire Scope - NO FIRE FEE <br />Review/ Inspection Scope -ADD FIRE FEE <br />fApprovedTT. Date: <br />R%ECTR.IGALINLUMBING <br />Additional Notes: <br />Approved By: Date, <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />No Use <br />Residential Use <br />Proposed No, of Dwelling Units: <br />Total No, of Dwelling Units: <br />PIanninglLandscape Inspection Required before Final? CIYes []No <br />"in Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist E]Mukilte0 School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park Impact Fee Total (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): ' <br />.- <br />PermitTechnicianUseOnly:ApplyPhase-inCredit Per EMC19.63.200 ........ <br />❑ 100% Credit- Issued 1/1/2022 - 9/2/2022 <br />❑ 50% Credit - Issued 9/3/2022 - 6/2/2023 <br />❑ 0% Credit - Issued 6/3/2023 o iater <br />Additional Notes: <br />mffin K4/W 00 <br />Approved By: Date: <br />Pukic WO1tKS <br />Intake OK by: Date: <br />Intake Comments: *PWWorksheetlVeededif: ���........... <br />'ElSys Dev EvaI (lltiltsvv) ❑Traffic Mit Eval <br />dSite Work/Drainage I_IAddress Letter <br />ClSackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />,supportive housing) <br />~.~.. <br />❑Route this folder for PW Review at end- -- PWRevlew Wbrksheet <br />[]This project also has a separate concurrent PW Review (Green Folder) <br />AND []Create Green Folder [Submitted Previously []Deferred <br />[] This Permit is Approved by Public Works <br />[] See PW Review Worksheet and associated attached items <br />A Separate PW Permit is Required (Permit #k: PW ) <br />AND d Is located in this folder <br />[] is in a Separate Green Folder Qoln with this fo►derfor permit issuance) <br />Q Will be issued separately (separate Green Folder, PW issued ahead of Bldg) <br />Public Works has no scope -- PW Not Required <br />Additional Notes- <br />AURA,"mmZ' <br />UM <br />Completed D Date: <br />