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Intake & Approval Sheet •(FOR PERMIT STAFF ONLY) PERMIT# 3 ZZ 1 Z- 0 9-7 <br /> BUILDING �LANNING I <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone t1,..) <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use J)) i ttlen Ill <br /> ❑ Make this a"W"Permit Proposed No. of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size 76/1° ,e.F Total No.of Dwelling Units: _ W 2, <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes 'No <br /> Number of Stories / "In Lieu"Fee: Type: Amount$ <br /> Basement 15INo ❑Yes , Fin/Unfin School Impact Fee: Total $ IBC <br /> Type of Construction VQ Calculated: Credit: <br /> Occupancy Group a DEverett School Dist ❑Mukilteo Scho ist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: 0/A-7— <br /> Fire Sprinklers: ❑Update Existing ❑New System 12KINot 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 El New System InNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per 19.53.200 <br /> Reason Fire Alarm Required: 1�1 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ®;No 0 50%Credit-Issued 9/3/2022-6/2/202 <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes No ❑ 0%Credit-Issued 6/3/2023 or lat <br /> VALUATION CALCULATION: Total $ZZ if/vas,00 Additional Notes: (.41 c5 CALL., . eft11-6Ae '^'1N <br /> . 4100x‘i (ui- ci a <br /> Approved By: t • .1 Date: q,i✓j. � <br /> •i BLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> OSys Dev Eval(Util/SW)❑Traffic Mit Eval <br /> Approved B Date O? /J/Zj 3 ❑Site Work/Drainage DAddress Letter <br /> / —_ <br /> ❑Backflow Prevention for high ha <br /> zard: <br /> azard: <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 /> %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 ❑A Separate PW Permit 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 ElIs in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:K co �.n Date ,-g,„73 ID Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> CA <br /> Additional Notes: 1--Tca.`S *VEZ C)6I ?IW ,me SYS D44 o'i' w <br /> freust <br /> Approved By: Date: Completed By�jq,��i_✓b Date: 'Or(ecru <br />