Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 13v�30 S�Q6,9 <br /> BUILDING • •ANNiNG <br /> Intake OK by: Date: intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone MO <br /> Overlay/Agreement <br /> 0 Route to Commercial Building Nonresidential Use ; U10 via/ U <br /> r . <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size 4-LaeP Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories t "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group T. El Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing IZINew System El Not•Req'd Park Impact Fee Total$ /---- (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: Update 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 X No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ ''1 Additional Notes:tEYt22.-)L.f t -' Qi ' affrOVCA u_ <br /> Y Pi <br /> p By: Date: <br /> PUBLIC WORKS . ' <br /> Additional Notes: ` 4„,r-r ar4+ iia tt44- Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> DSys Dev Eval(Utii/SW) ❑Traffic Mit Eval <br /> Approved By: . ' Date: lofrt/ b O ❑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 /> El 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 /> ❑This Permit is Approved by Public Works <br /> Fire Dept.Fees: ❑ See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FiRE FEE 0 A Separate PW Permit is Required(Permit#: PW ) <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(join with this folder for permit Issuance) <br /> Approved By: K,S,r0,,,y, Date: to'-677 ❑Will be issued separately(Separate Green Folder,PW Issued ahead of ikfrublic Works has no scope---PW Not Required <br /> ELECTRICAL/RLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By �f, - Date: 63126211 ot2 <br />