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Intake & Approval Sheet *FOR PERMIT STAFF ONLY) PERMIT# D22-i t b.- 01°1 <br /> PM BUILDING I LANNING <br /> Intake OK by: 'PM Date: 10(S1 22-- Intake OK by: Assign To: Date: I 0/05/Z2. <br /> Intake Comments: Intake Comm n ni"s: 1 <br /> Zone (Z,-X <br /> Overlay/Agreement IQ/A <br /> ❑ Route to Commercial Building Nonresidential Use MI A <br /> Route to Residential Building Residential Use S F (Z <br /> oMake this a"W" Permit Proposed No.of Dwelling Units: t <br /> Bfd 1/Addn/Rem Size -5 13 Total No.of Dwelling Units: I. <br /> ar g Accessory Struct. Size 55 $ Planning/Landscape Inspection Required before Final? ❑Yes IgNo <br /> er of Stories "In Lieu" Fee:Type: Amount$ 0 <br /> Basement No ❑Yes , Fin/Unfin s School Impact Fee: Total $ rJ 35 <br /> Type of Construction WL Calculated: Credit: <br /> Occupancy Group ,C- Fal verett School Dist ❑Mukilteo School Dist <br /> Occupancy Load zILC' Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System ITJ Not Req'd Park Impact Fee Total$ 2.p 82'3 <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 2.02 Z. <br /> Fire Alarm: El Update Existing ❑New System Not Req'd Permit Technicians:Apply 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? ❑Yes . I No A 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 2I No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ `I lit c3�7 Additional Notes: <br /> e 16 6 isv -7-i Liz-17 1 t'6 <br /> .q-cc 66 I s 7- 4 147(8 o Approved By: ��•_ '�� Date: !D 05 ZZ <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: -AL Date: dG— osi— Zni z <br /> Intake Comments: ( PW Worksheet Needed if: <br /> 7.11 Rk'1 M'Q*_S gSys Dev Eval IN Traffic Mit Eval <br /> Approved By:AE-pi f O( K y N Date: k 1 4 Z,3 ' parex,.'t,e.cQ NilSite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <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 DOther: L1This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND giCreate Green Folder ❑Submitted Previously ❑Deferred <br /> VI This Permit is Approved by Public Works <br /> Fire Dept. Fees: W See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE KA Separate PW Permit is Required(Permit#: PW 22t©-0O 1 ) <br /> Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE -a-Sepafate-Greet--F6tdet ;n i h this er for permit issuance) <br /> Approved By:K ,(.0„,, Date: lD-11._22 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING �n � <br /> Additional <br /> Notes: / <br /> Additional Notes: vQ`, y -2L t3 10 r'SS 1 82e, <br /> Approved By: Date: Approved By; ,jna De: �,tat p '2;�5L7 <br />