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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1 304 0O <br /> BUILDING • P ..NING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <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 /> Bldglil/Addn/Rem Size ,,31/7 Total No.of Dwelling Units: <br /> Garage/Accessory Struct. Size S.- II7$ _ Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories ram/ "In Lieu" Fee:Type: Amount$ <br /> Basement t'tNo ❑Yes, Fin/Unfin School Impact Fee: Total $ Lo 249; <br /> Type of Construction Calculated: �{ _s(9 Credit: — 51 — <br /> Occupancy Group ..7-2 G Everett School Dist t ❑Mukilteo School Dist <br /> Occupancy Load 6 Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: DUpdate Existing ❑New System IgNot Req'd Park Impact Fee Total$3/8G (net due aft c ditfor existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): vC 2 <br /> Fire Alarm: ❑Update Existing ONew System Mot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 11 No ❑ 50%Credit-Issued 0/3/2022-6/2/2023 <br /> Add'1 RCW 64.55 does required prior to final? ❑Yes pNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 7`/Z k Additional Notes: <br /> /etcfx /,fit — r13 y Z <br /> Approved By: Date: el__0/2 <br /> - 47Srl/ <br /> PUBLIC WORKS • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if• <br /> ❑Sys Dev Eval(Util/sVV) DTraffic Mit Eval <br /> Approved • • Date:p /7� / ,3 ❑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: DRoute 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: gs See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE IA Separate PW Permit is Required(Permit##: PW 2364'0(Z ) <br /> Minimal or No Fire Scope-NO FIRE FEE AND RLIs located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br /> Approved By: ,E3 c-c2Gu n Date: 7 G LI 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 /> Additional Notes: <br /> Approved By: Date: Completed 13 . Date: 4.)¢1j1r1023 <br />