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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 303 '031( <br /> BUILDING ANNING l <br /> Intake OK by: Date: Intake OK by: Assign To:JSSS Date:4I(o r <br /> Intake Comments: Intake Comm s: <br /> Zone R-I, <br /> Overlay/Agreement Nor e.. <br /> ❑ Route to Commercial Building Nonresidential Use u/A <br /> ❑ Route to Residential Building Residential Use A S H <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: N/A <br /> Bldg/TI/Addn/Rem Size Total No. of Dwelling Units: <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes- No <br /> Number of Stories "In Lieu" Fee:Type: Amount$ <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Calculated: C dit: <br /> Occupancy Group ❑Everett School Dist ❑Muki o School Dist <br /> Occupancy Load ,,--- Park Impact Fees for permits ap led for after 1/1/2022: <br /> Fire Sprinklers: DUpdate Existing ONew System I� I��Not.Req'd Park Impact Fee Total$2 IZ.O (net due after credit for existing uses) <br /> Reason Sprinklers Required: r� Fee Schedule Used For Calculation(Year): 2023 <br /> LYI <br /> Fire Alarm: ❑Update Existing ONew System Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? DYes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ 635 Additional Notes: ,�µ,a Io(tZl/ <br /> 23 <br /> Approved By: Date: +i be 1 z 3 <br /> PUBLIC WORKS • •• <br /> Additional Notes: Intake OK by: Date: <br /> \ p�� Intake Comments: PW Worksheet Needed if: <br /> N`w rat "Q"~4e4 P ? 1� XSys Dev Eval(Util DTraffic Mit Eval <br /> ,NLts �y CONcr WoaK <br /> Approved By: Date: \0 —ia_1 ✓ �"y Site Work/Drainage DAddress Letter <br /> gG►V tSO*cre- z (4,ga. ❑Backflow Prevention for high hazard: <br /> Ntw GONd.-a4 ifi g (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 DOther: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> TA 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 El A Separate PW Permit is Required (Permit#: PW 2303'0O / ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ,I is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ 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 /> ❑ Public Works has no scope---PW Not Required <br /> EL.IrCTRICAL/I?LUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By •. `>` Date: V �2 <br />