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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# , 3°6 — OC, <br /> BUILDING DINING <br /> Intake OK by: Date: Intake OK by: 121(b Assign To: 1:14 Date:13 I olv, 2o' ' <br /> Intake Comments: Intake Comments: <br /> Zone $ <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use COAAIKVfA A) <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size —70 ti Total No. of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ti,Yes ❑No <br /> Number of Stories t "In Lieu" Fee:Type: Amount$ <br /> Basement iNo ❑Yes , Fin/Unfin School Impact Fee: Total $ IJ►A <br /> Type of Construction VS Calculated: Credit: <br /> Occupancy Group t DEverett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 1 g Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: DUpdate Existing ❑New System IiNot•Req'd Park Impact Fee Total$ 183 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): tb2% <br /> Fire Alarm: DUpdate Existing ❑New System ®Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <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 FL No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? U .-- 1is \• V 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ kgbL . , Additional Notes: 2100 4f % . 2.9 =4163 ?I F <br /> IIIIMIII <br /> (- ---10 Lt 6/1I'u Approved Sy:Latij,j,6� Date: y2073 <br /> PUBLIC WORKS . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> l Sys Dev Eval(Util/sW) Qeiraffic Mit Eval <br /> Approved By: ( ,t. 6 Date:• t 1' ).,2../;-/ S1,6 P W 2 3 0 5'b 0 b Fite Work/Drainage CYAddress Letter <br /> T'wn'^N, G t {,'1/,.. DBackflow Prevention for high hazard: <br /> •J_ (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT Er/Route supportive housing) <br /> Separate/Deferred Submittals Required: / this folder for PW Review at end --PW Review Worksheet <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: L�1 his project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder 14Submitted Previously ❑Deferred <br /> UT This Permit is Approved by Public Works <br /> Fire Dept.Fees: rlSee PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE ®A Separate PW Permit is Required(Permit#: PW 1- 05"003 ) <br /> ❑ Minimal or No Fire Scope-NO FIR AND 0 Is located in this folder El j 6 AA ei <br /> rA Review/Inspecti <br /> on Scop -ADD IRE FEE ElIs in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By:\, (�Il�n are: ii-p-/-.25 <br /> _7 2.' ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 1 J ` 0 Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: ail,t JA k', no"wfic ry iI I h ti4 ►vt,+UA <br /> Approved By: Date: Completed By:. ,(,(/l Attyryinet,, Date: o1l I I I 2,Z 2eii <br />