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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# P7'3O 1 OZZ <br /> BUILDING LANNING <br /> Intake OK by: Date: Intake OK by: �/ Assign To: less Date: 7/2(v/Z3 <br /> Intake Comments: Intake Commer1W <br /> Zone 0RL1 <br /> Overlay/Agreement Al A,Gonneckbr sarre.eA- <br /> ❑ Route to Commercial Building Nonresidential Use u/A <br /> ❑ Route to Residential Building Residential Use M v I}i_fra,,v1;1 y <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: N/Pr <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: ZO► -3Oo vr,iks, ec7+,}s ope. <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? bYes ❑No <br /> Number of Stories 0 "In Lieu"Fee:Type: Amount$ 0 <br /> Basement INNo ❑Yes , Fin/Unfin School Impact Fee: Total $0 <br /> Type of Construction V'A Calculated: Credit: <br /> Occupancy Group /2.---Z. ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System ,lot Req'd Park Impact Fee Total$ 0 <br /> Reason Sprinklers Required: I/ Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System fr 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 ,1 No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes J No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 24-4)(1',d J Additional Notes: <br /> Approved By: b: ---- Date: 7/Z(o/2 3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: I PW Worksheet Needed if: <br /> ❑Sys Dev Eval ©Traffic Mit Eval <br /> Approved B Date:Q7/ `2✓7� Site Work or Drainage Proposed <br /> =OBackflow Prevention for high hazard: <br /> 1(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT ;supportive housing) <br /> Separate I Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> ❑Fire Sprinklers JFire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑ 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 ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: ..F Q,C...4) Date: 8 —3 3 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: .( Date: o? 1 V412c4tJ <br />