Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# G.c9,3 45'— 0 5-q <br /> BUILDING _ANNING WI—r ' t5 <br /> intake OK by: Date: intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone A/6' <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use A <br /> ❑ Route to Residential Building Residential Use 1' <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: i <br /> Bidg/TllAddn/Rem Size I -7 2.7 Total No.of Dwelling Units: ! <br /> Garage/Accessory Struct.Size 4 I/ Planning/Landscape Inspection Required before Final? IJZIYes ❑No <br /> Number of Stories F--. <br /> ,,��..��// ) "in Lieu"Fee:Type: • Amount$ <br /> Basement L1No ❑Yes, Fin!Unfin School Impact Fee: Total $ ,�f f Se <br /> Type of Construction L Calculated: f// �f /6, Credit: —Occupancy Group ❑Everett School Dist Aukilteo School Dist <br /> Occupancy Load iL Park Impact Fees for permits a plied for after 1/1/2022: <br /> Fire Sprinklers: DUpdate Existing ❑New System lNot'Req'd Park Impact Fee Total$ ,/'p (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): ..200 3 <br /> Fire Alarm: ❑Update Existing ❑New System INot 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? ❑Yes �h' No ❑ 50%Credit-Issued V3/2022-6/2/2023 <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes $No ❑ 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3`5 Jsok az> Additional Notes: <br /> k'.21Y- tto(r . <br /> y( t X (o (o 1..A.L_ Approved By: Date: ....,-.25 - ' .Z,, <br /> 32 )C La Ls PUBLIC WORKS . . .. <br /> Additional Notes: intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> ❑Sys Dev Evai(Util/Sint) ❑Traffic Mit Eval <br /> Approved By: Date: ( I z_- 2-3 ❑Site 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: ❑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 /> • <br /> This Permit is Approved by Public Works <br /> Fire Dept.Fees: liil See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE 54 A Separate PW Permit is Required(Permit#: PW 2.24,S -o22) <br /> ❑ Minimal or No Fire Scope-NO FiRE FEE AND 0 Is located in this folder <br /> TE Review/inspection Scope-ADD FIRE FEE i❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:�ZcofA)`( Date: 13-3-2 3 lit Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> q.-�� £3 0 Public Works has no scope--PW Not Required <br /> EL CTRICALIRLUM.BING • Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed Byt------et. ^ _„.de Date: ,512-1 1'z - <br />