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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# g,,--3o. ®6 ( <br /> BUILDING II _ANNiNG GtiJ t r p <br /> intake OK by: Date: intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ,./. <br /> Overlay/Agreement <br /> 0 Route to Commercial Building Nonresidential Use / <br /> ❑ Route to Residential Building Residential Use 7 <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: / <br /> BIdg/TI/Addn/Rem Size U7? .7 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size (f' I I Planning/Landscape Inspection Required before Final? Yes ❑No <br /> Number of Stories "In Lieu"Fee:Type: ' .- —"Amount$ <br /> Basement rgNo ❑Yes, Fin/Unfin School Impact Fee: Total $ ///1 y`o <br /> Type of Construction Zg(. Calculated: // 90' Credit: <br /> Occupancy Group 7/(2'< ❑Everett School Dist gIVIukilteo School Dist <br /> Occupancy Load j1z.C Park Impact Fees for permits applied for after'i/112022: <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fee Total$ 3/$ (net due aaffftt_,err reditfor tin uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System 13tNot 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 No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'l RCW 64.55 does <br /> required prior to final? ❑Yes No El 0%Credit-issued 6/3/2023 or later <br /> q <br /> VALUATION CALCULATION: Total$^ Additional Notes: <br /> _t i l.Jc L.---- Approved By: ,.6:::2 'Date: Q /�-- <br /> f <br /> PUBLIC WORKS • ' • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed If <br /> r ❑Sys Dev Eval(Util/SW)❑Traffic Mit Eval <br /> Approved By: (./V� Date: (i/Z(y s ❑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 /> 54-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 /> 10 This Permit is Approved by Public Works <br /> Fire Dept.Fees: K See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE IZA Separate PW Permit is Required(Permit#: PW 2-7-0 S"-o22 ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: YidGV r Date:p—3-.2 54 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> T 2. -' Z 6 ❑ Public Works has no scope---PW Not Required <br /> EL.ECTRICAL/RLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed Date: 6,5(1-7 1 L 3 <br />