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Intake eft Approve]sheet (1'Ut 1-1 11111111 S 1 Aft~ ONLY) PERMIT# o 0 <br /> BUILDING SINNING <br /> Intake OK by: Date: intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone LI'2 <br /> Overlay/Agreement <br /> El Route to Commercial Building Nonresidential Use uPj 'Y iC,0.0 f %r U <br /> ❑ Route to Residential Building Residential Use <br /> El Make this a"W"Permit Proposed No.of Dwelling Units: <br /> B1dglTl/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? CIYes ONo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ONo ['Yes, Fin/Unfin School impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist DMukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 11112022: <br /> Fire Sprinklers:OUpdate Existing ONew System ❑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 ONew System ONot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EVICI9.53.200 <br /> Reason Fire Alarm Required: El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? DYes El No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'l RCW 64.55 docs required prior to final? CIYes CINo El 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$/27 aO67,062 Additional Notes: <br /> PiTth'SVADO z-t0)/ 3 <br /> Approved By: Date: <br /> PUBLIC WORKS • . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> DSys Dev Eval(Util/sW)EiTraffic Mit Eval <br /> Approved kiiiik-rvi4 Date: /,q Z t� Z ` DSite Work/Drainage tlAddress Letter <br /> • DBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DPPARTIVII~NT supportive housing) <br /> Separate/Deferred Submittals Required: ❑Route this folder for PW Review at end --PW Review Worksheet <br /> ❑Fire Sprinklers ❑Fire Alarm ['Other: OThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND}Create Green Folder ['Submitted Previously ❑Deferred <br /> • <br /> El This Permit is Approved by Public Works <br /> Fire Dept Fees: El 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 /> rrQ Minimal or No Fire Scope-NO FiRE FEE AND Et Is located in this folder <br /> ]�1-Review/Inspection Scope-ADD FIRE FEE ❑ is in a Separate Green Folder(loin with this fofrierfor permit issuance) <br /> Approved By:-g, Date: El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> IX Public Works has no scope--PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: -tainityidnut mom/ 6t4 1246) L3 <br /> Approved By: Date: Complet By: Date: <br />