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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 3?.30 - 060 <br /> BUILDING m _ANNiNG (A/Orr <br /> intake OK by: Date: intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone N ts <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use .t''" <br /> El Route to Residential Building Residential Use '%(/ <br /> El Make this a NV Permit Proposed No.of Dwelling Units: / <br /> BIdg/TllAddn/Rem Size ( 7 z 7 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size C4 () Planning/Landscape Inspection Required before Final? Yes ❑No <br /> Number of Stories "in Lieu"Fee:Type: Amount$ <br /> Basement TANo DYes, Fin/Unfin School impact Fee: Total $ ///,f ,( <br /> Type of Construction -q.(• Calculated: // SC/6v Credit: - -- <br /> Occupancy Group "'(, A. DEverett School Dist Vlukilteo School Dist <br /> Occupancy Load - LL Park Impact Fees for permits Aplied for after 1/1/2022: <br /> Fire Sprinklers: DUpdate Existing DNew System r Not Req'd Park Impact Fee Total$ 7/111 (net due after cref_r dit existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): .2edi <br /> Fire Alarm: DUpdate Existing ONew System IRINot 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 tI No ❑ 50%Credit-Issued 0/3/2022-6/2/2023 <br /> Add]RCW 64.55 docs required prior to final? DYes It No ❑ 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ J et ZO Additional Notes: <br /> J IQ4(_____ Approved By: �y--Date: 70 ;/v-- ..2 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/SW)❑Traffic Mit Eval <br /> Approved By: /-...— Date: ((701) ❑Site Work/Drainage )Address Letter <br /> DBackflow Prrevention for high hazard: <br /> FIRE DEPARTMENT . supportive an(mals,mortuary,hospital, <br /> PP housing) <br /> Separate/Deferred Submittals Required: DRoute this folder for PW Review at end --PW Review Worksheet <br /> Of ireSprinklers ❑Fire Alarm ❑Other: DThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> 7•2 This Permit is Approved by Public Works <br /> Fire Dept.Fees: RI See PW Review Worksheet and associated attached items <br /> 0 Review of As-Built Plans-NO FIRE FEE £ A Separate PW Permit is Required(Permit#:PW 2.1-65%d22 ) <br /> ❑Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> la-Review/inspection Scope-ADD FiRE FEE rr0 Is in a Separate Green Folder Uoin with this folder for permit issuance) <br /> Approved By:K co Gun Date:g-3 Z3 !a'Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> q v--,23 0 Public Works has no scope--PW Not Required <br /> ELI~CTRICAL/RLUMBING Additional Notes: <br /> Additional Notes:Approved By: Date: , Completed By.� �� Date: 5I Z1 p r <br /> Zo 23 <br />