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Intake 254.HpptrOita, meet (rUK 1-' 11.ivi11 IArt- WILY) PERMIT# (��3oc -p bl <br /> BUILDING • (ONNING • <br /> intake OK by: Date: intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 12 <br /> • <br /> Overlay/Agreement <br /> El 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 /> Bidg/TllAddn/Rem Size Total No.of Dwelling Units: <br /> Garage Accessory Struct.Size 6S 9 S PIanninglLandscape Inspection Required before Final? Clues LINO <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement Elio Dies, Fin/Unfin School impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist DMUkilteo School Dist <br /> Occupancy Load ' 3i26 Park Impact Fees for permits applied for after 11112022: <br /> Fire Sprinklers:DUpdate Existing ONew System , Not•Req'd Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ElUpdate Existing ONew System jNot Req'd Permit Technician Use Only:Apply Phase-in Credit Per EMCI9.53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit-issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? DYes No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'1 RCW 64.55 dots required prior to final? DYes rfNo ❑ 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ OOC) Additional Notes: <br /> 1‘47 9/2 /23 • <br /> Approved By: Date: <br /> PUBLIC WORKS • . <br /> Additional Notes: intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> OSys Dev Eval(UtiIfsw)DTraffic Mit Eval <br /> Approved By: V.-RA Date: 5/3 f2cz Mite Work/Drainage ClAddress Letter <br /> DBackflow Prevention for high hazard: <br /> (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 ❑Fire Alarm Other: EIThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate Green Folder EISubmifted Previously ElDeferred <br /> • <br /> IrA This Permit is Approved by Public Works <br /> Fire Dept.Fees: Cl See PW Review Worksheet and associated attached items <br /> o Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#: PW ) <br /> 0 Minimal or No Fire Scope-NO FIRE FEE AND El Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FiRE FEE El Is in a Separate Green Folder(loin with this folderfor permit issuance) <br /> El By: Date: Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> El Public Works has no scope--PW Not Required <br /> ELECTRICAL/PLUMBING Additio al Notes:S+OrlY1 t Vvtirlet 10( s ) <br /> Additional Notes: `5 � ht) S-1zyyv'1�✓ <br /> Approved By: Date: Completed By: Date: t ThZ 6 <br />