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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Bct)9-Or'7 <br /> BUILDING 111 •LANNING <br /> Intake OK by: eL Date: kD Cit 1:1;2- Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone 1G Z <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> .Route to Residential Building Residential Use `Ji — <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: — <br /> BBldgF/TI/Addn/Rem Size ��^^ Total No. of Dwelling Units: I <br /> Garag"Accessory Struct. Size b Z.� Planning/Landscape Inspection Required before Final? ❑Yes El <br /> er of Stories I 1 "In Lieu" Fee:Type: Amount$ <br /> Basement LNo ❑Yes , Fin/Unfin School Impact Fee: Total $ N// <br /> Type of Construction ..j C_ - Calculated: Credit: <br /> Occupancy Group lid ❑Everett School Dist ❑Mukilte ool Dist <br /> Occupancy Load IV—. Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System lallot Req'd Park Impact Fee Total$ 1 <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 'V /� <br /> Fire Alarm: ❑Update Existing ❑New System gNot Req'd Permit Technicians:Apply Credit Per EMC .53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/ 022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑ 50%Credit-Issued 9/3/2022- /2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes in No 0 0%Credit-Issued 6/3/202 or later <br /> VALUATION CALCULATION: Total$ 7, f) 'ZI Additional Notes: <br /> Approved By: V .\ , Date: \ <br /> ,1�j, �j <br /> t' BLIC WORKS <br /> Additional Notes: Intake OK by: &9 Date: v!113 1222-- <br /> Intake Comments: PW Worksheet Needed if: <br /> p1it 6 wywAz/051.0 a vlsys Dev Eval ❑Traffic Mit Eval <br /> Approved By: H Date: 47_12_2— a,t k4 Ate) )Sitite Work or Drainage Proposed <br /> t ySt' % (p2,/4 i ❑Backflow Prevention for high hazard: <br /> P of S�1. Is l I{✓ (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT Y � ( , U supportive housing) <br /> Separate/Deferred Submittals Required: DRoute this folder lfor'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 /> RI This Permit is Approved by Public Works <br /> Fire Dept. Fees: I,See P eview Workshee nd associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE 0 A Separa rmit is Required (Permit#: PW ) <br /> ❑ Minimal or No Fire Scope- NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: ,c31 - —i—t4+ka ',( <br /> Additional Notes: Set w �,Q(t�1 <br /> Approved By: Date: Approved By: � Date: l Z3 '2dLZ <br /> t kl1 ••tg'� <br />