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1ntaKe Approval sheet (1-Ut<.N.�.t11V111 S I AH- ONLY) PERMIT# . ©L3D(f- 0611 <br /> BUILDING PeNINC • <br /> Intake OK by: Date: Intake OK by;/o Assign To:Jess Date: 5/2/23 <br /> Intake Comments: Intake Comments: <br /> Zone A.Z <br /> Overlay/Agreement AI A•ACP% <br /> Q Route to Commercial Building Nonresidential Use N/A <br /> Q Route to Residential Building Residential Use 5 F R. <br /> Q Make this a"W"Permit Proposed No.of Dwelling Units: N/A <br /> BldglfilAddn/Rem Size Vie, - -t Total No.of Dwelling Units: <br /> Garage/Accessory Struct,Size PlanninglLandscape Inspection Required before Final? QYes K(No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ 0 <br /> Basement QNo QYes, Fin!Unfin School Impact Fee: Total $ 0 <br /> Type of Construction I CU-- Calculated: Credit: <br /> Occupancy Group i Roc QEverett School Dist QMukilteo School Dist <br /> Occupancy Load l' C- Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: QUpdate Existing ONew System 1 lNot Req`d Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: QUpdate Existing QNew System $2,Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMCI9,53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit_Issued 1/1/2022-9/2/2022 <br /> ROW 64.55 MF worksheet req'd for permit? QYes 14 No ❑ 50%Credit-Issued$/3/2022-6/2/2023 <br /> Add'l RGW 64.55 daps required prior to final? QYes gNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 1,0 7 Additional Notes: <br /> Approved By: Date:5/2/2.3 <br /> PUBLIC WOEtK <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> QSys Dev Eval(Util/SW)OTraffic Mit Eval <br /> Approved By: i Date: 401,1.—/l z 1_ISite Work/Drainage DAddress Letter <br /> • ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> •FIRE DEPARTMENT • supportive housing) <br /> Separate/Deferred Submittals Required: DRoute this folder for PW Review at end --PW Review Worksheet <br /> QFire Sprinklers QFire Alarm QOther: QThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND QCreate Green Folder ❑Submitted Previously QDeferred <br /> • <br /> NJ This Permit is Approved by Public Works <br /> Fire Dept Fees: Q See PW Review Worksheet and associated attached items <br /> Q Review of As-Built Plans-NO FIRE FEE Q A Separate PW Permit is Required(Permit#:PW ) <br /> Q Minimal or No Fire Scope-NO FIRE FEE AND Q Is located in this folder <br /> Q Review!Inspection Scope-ADD FIRE FEE Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By: Date: Q Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Q Public Works has no scope--PW Not Required <br /> EL,ECTRICAL/PLUMBING • Additional Notes: <br /> Additional Notes: ')'�,p s Leoir W l <br /> Approved By: Date: Completed y: / 11I JVi,,fY elex Date: 0 140�23 <br />