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Intake & Approval Sheet 'FOR PERMIT STAFF ONLY) PERMIT# �j Zap Z, - Q4(, <br /> BUILDING .ANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement - <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> BI I/Addn/Rem Size 7, g'' 1f Total No. of Dwelling Units: 1% <br /> Garage/Accessory Struct. Size A/D Planning/Landscape Inspection ;,-ow -d befor: Final? ❑Yes ❑No <br /> Number of Stories 2— "In Lieu" Fee: Type: Amo nt$ <br /> Basement ZNo ❑Yes , Fin/Unfin School Impact Fee: Total $ /I/14' <br /> Type of Construction V Q _ Calculated: Credit: <br /> Occupancy Group S ❑Everett School Dist ❑Mu'' chool Dist <br /> Occupancy Load t1'7 Park Impact Fees for permits a Iliad for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing New System ❑ ,��Not Req'd Park Impact Fee Total$ r ---et duel <br /> aftercreedit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 9 0? <br /> Fire Alarm: ❑Update Existing ENew System ❑Not Req'd Permit Technician Use Only:Apply Phase-In 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 In No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add]RCW 64.55 docs required prior to final? ❑Yes pNo ❑ 0%Credit-Issued 6/3/2023 or later 7 <br /> VALUATION CALCULATION: Total$ I.tr Z.p1 Additional NCLote:/(0/w/2/-/ iv,14 /�• sac 'O f!0. - z <br /> ,tirS t,/r �y _/•f h k Ite, v(/�"l ! - `,,?ivy /✓r 4/, ,Ai.> , /'/.,'4,, <br /> 7 giro x /8l = /.e/z/pr a <br /> Approved Byi/ C--7: ( , c( _ 1 1 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if. <br /> DSys Dev Eval(Util/s1n0 OTraffic Mit Eval <br /> Approved By\r\) v"`� Date:06/077�1-0Z,? ❑Site Work/Drainage DAddress Letter <br /> OBackflow 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 Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> 0 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 located in this folder <br /> 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ®.Review/Inspection Scope-ADD FIRE FEE <br /> /y�� 0Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ,Ko(�)- Date: <br /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />