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(14, <br /> Intake &Approval Sheet OR PERMIT STAFF ONLY) di PERMIT# 0'1'-Uc( <br /> BUILDING PrANNING <br /> Intake OK by: Date: Intake OK by: ei Assign To: J e.SS Date: 'fi 5/23 <br /> Intake Comments: Intake Commen <br /> Zone M U <br /> Overlay/Agreement C°D.US. t piv.p�euo t t,O <br /> ❑ Route to Commercial Building Nonresidential Use Clih'tc <br /> ❑ Route to Residential Building Residential Use N/Afi <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: N/p1 <br /> Bldg/1y4ddn/Rem Size 'IA,If? Total No.of Dwelling Units: MA . <br /> Garage/Accessory Struct.Size t N Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Number of Stories 1 "In Lieu"Fee:Type: Amount$ 0 <br /> Basement ENo ❑Yes , Fin/Unfin School Impact Fee: Total $ 0 <br /> Type of Construction Vb Calculated: Credit: <br /> Occupancy Group Q ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 1 Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: Update Existing ONew System ❑Not Req'd Park Impact Fee Total$ (� �' no <br /> yr~osc s c "� use �c� <br /> P P f assessir+g <br /> Fee Schedule Used For Calculation(Year): 23 VeeS <br /> Reason Sprinklers Required: ( ) <br /> Fire Alarm: Ill Update Existing ❑New System ❑Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add.]RCW 64.55 docs required prior to final? ❑Yes ONo 0 0%Credit-Issued 6/3/2023 or later <br /> u <br /> VALUATION CALCULATION: Total$ MIL udJ Ifl , Additional Notes: <br /> Approved By:Alitteetw Date: e/15/2 .3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: . 4 Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> I❑Sys Dev Eval liTraffic Mit Eval <br /> Approved By: („ �c. �A` Date: 9 Il `a„3 <br /> i❑Site Work or Drainage Proposed <br /> I❑Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT _supportive housing) <br /> Separate I Deferred Submittals Required: DRoute this folder for PW Review at end ---PW Review Worksheet <br /> }Fire Sprinklers Rg Fire Alarm DOther: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ��1 This Permit is Approved by Public Works <br /> Fire Dept.Fees: 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND Is Is located in this folder <br /> VI-Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:K,E5 cow Y' Date: S -3 423 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By ;y �2.Oc Date: 0.7.31_2'al_ <br />