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Intake 8 Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 5 Z 0 ' - ( 6 <br /> BUILDING _ _ANNING <br /> Intake OK by: Date: Intake OK by: t* Assign To: Date: 6Ft 2413 <br /> Intake Comments: Intake Comments: 66 Iti it014,6 kEVI <br /> Zone R2 <br /> Overlay/Agreement A;,r?or{ ItStutn,ct, Ataa <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use ivW - 441" <br /> ❑ Make this a"W"Permit Proposed No. of Dwelling Units: 2 <br /> V Bldg/TI/Addn/Rem Size 225XSF Y Z=41g2j: Total No. of Dwelling Units: Z <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? Yes ❑No <br /> Number of Stories Z "In Lieu" Fee: Type: ''1 A Amount$ <br /> Basement cNNo ❑Yes , Fin/Unfin School Impact Fee Total $ iti 4b <br /> Type of Construction l P C Calculated: 23,VI2 Credit: Iljf 'II-Co--- <br /> Occupancy <br /> Group ( 12—C DEverett School Dist FIMukilteo School Dist <br /> Occupancy Load I k.-c- Er Not <br /> rk I eesmpact F or permits applied for after 1/1/2022: <br /> Fire Sprinklers. DUpdate Existing ❑New System E1Not Req'd Park Impact Fee Total$ $, I 10 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 2 023 <br /> Fire Alarm: ❑Update Existing ONew System EiNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: D 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? DYes Ei No 0 50%Credit Issued 9/3/2022-6/2/2023 <br /> Add'i RCW 64.55 docs required prior to final? ❑Yes No 13 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total $ <41,2/Ob O Additional Notes: a. #i ^ Ict%rr OA f01.(at lerio Nab f <br /> AA maocvrcf i` <br /> . , 4rA iAtc,k0 viii1, P(I <br /> Approved By: \ ,}: _� r,4 i- Date: A; /N a,j 2Oy2 <br /> • "� PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: D\R2-1D12' <br /> Intake Comment . PW Worksheet Needed if. <br /> '1 rei►wv� l t <br /> sP�Q Sys Dev Eval(Util/SW)54Traffic Mit Eval <br /> Approved By: 1,D� Date: / Z 2 X. <br /> L lSite Work/Drainage lAAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate/Deferred Submittals Required: ®Route this folder for PW Review at end ---PW Review Worksheet_ <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: This project also has a separate concurrent PW Revi (Green Folder) ,) <br /> Additional Notes: Y4i : AND ❑Create Green Folder ❑Submitted Previously Deferred <br /> no y�rin blurs Ar I d/a L. <br /> news 1• ) ig This Permit is Approved by Public Works <br /> Fire Dept. Fees: RSee PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE El A Separate�/ PW Permit is Required (Permit#: PW 23D1- DO ) <br /> El Minimal or No Fire Scope-NO FIRE FEE AND l7sl Is located in this folder <br /> -Review/Inspection Scope-ADD FIRE FEE In e d of f e) <br /> Approved By:)K, .,)fin Date: 1, -,,2 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 Adiclitional Notes: I 1 II <br /> Additional Notes: 4611,0 rn1/1- f J 1'Q0 4 p i YI\e,15 c\'11 Ai9'-W <br /> Approved By: Date: Completed By:i U Date: 0 U10,1 I ZUW? <br />