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Intake &Approval Sheet Ani (FOR PERMIT STAFF ONL1) PERMIT# 3 Z.3 0 7-- (O3 <br /> BUILDINGlir �LANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone lS <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use _ <br /> ❑ Route to Residential Building Residential Use . <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> Bldg/TI/Add em Siz) if1( ,tr Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size NA Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Number of Stories a, "In Lieu"Fee: Type: Amount$ <br /> Basement giNo ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction JRS Calculated: Credit: <br /> Occupancy Group TA6 ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 4-Le" Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fee Total$ / (net due aftercredit 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 EMCI9.53.200 <br /> Reason Fire Alarm Required: N> W,P RAIN ❑ 100%Credit-Issued 1/1/2022 9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1E1 No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add!RCW 64.55 docs required prior to final? ❑Yes Rallo ❑ 0%Credit-Issued 6/3/2023 or later /�i; ��1� <br /> VALUATION CALCULATION: Total$ l0/ fop Additional Notes: g 1L ze <br /> pArYka r • /2i 12 <br /> Approved By: Date: <br /> • PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if:: - <br /> ' S s Dev Eval(Utile[]Traffic Mit Eval <br /> Approved By: (` 4a�n► ‘oolh Date: l!71').y ZO $ ite Wor Drainage ❑Address Letter <br /> N. <br /> %ete j7api71 ,F Backflow Prevention for high hazard: <br /> Yeti-Arta- { (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT �" �' supportive housing) <br /> Separate/Deferred Submittals Required: El Route this folder for PIN Review at end ---PW Review Worksheet <br /> ❑Fire Sprinklers El 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'iteas , <br /> ❑ Review of As-Built Plans-NO FIRE FEE IAA Separate PW Permit is Required(Permit#:PW 3-DO'L ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND Is located in this folder <br /> El in a Separate Green Folder(join with this folder for permit issuance) <br /> El Review/Inspection Scope-ADD FIRE FEE <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: �( <br /> Additional Notes: �W SVSdGU 47 ``10 6 N 'Pl+N PEIZ.M l T <br /> Approved By: Date: Completed z„.?J <br />