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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# SoI:?/0 — 05. <br /> BUILDING .ANNING <br /> Intake OK by: “Vk Date: kZlb 'LZ— Intake OK by: ah Assign To: Viet Date: 30 ►Jo.+ 2'1 <br /> Intake Comments: Intake Comments: tovrcc{I1ly. Lctkv -0 assl 301•%ty- <br /> Zone a-z _ <br /> Overlay/Agreement <br /> r❑ Route to Commercial Building Nonresidential Use <br /> .IS-Route to Residential Building Residential Use SFQ <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> Bldg/Tl dd Rem Size -394 SC Total No. of Dwelling Units: l <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Number of Stories i "In Lieu" Fee:Type: 0 to Amount$ <br /> Basement Nlo ❑Yes , Fin/Unfin ` School Impact Fee: Total $ u IA <br /> Type of Construction Vt' Calculated: Credit: <br /> Occupancy Group 1Zti(, ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy LoadL Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: El Update Existing ❑New System rg Not Req'd Park Impact Fee Total$ a)A iveM4 # M <br /> 1 t. <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 11 •S3 •1l O•a•2 <br /> Fire Alarm: ❑Update Existing ❑New System igNot Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: D 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes rT No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes IZTNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ ZtV WO Additional Notes:..iv.ch1.e, rriw4..- ti. ROW It". •_c. . Q14 <br /> -00v144.4 a ov4 rc..cuc,, f-t., V►`Svw.t Nsvic •f-Aiv+ • <br /> Approved �By:�k}^_ ,( Date:1, .14;$1 'loll <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: V Date: 10 1 I20Z1 <br /> Intake Comments: PW Worksheet Needed if: <br /> eisM Ii1 PA Neu/, -re-1)l�l <br /> sia�mw PoL -Aw' Sys Dev Eval ❑Traffic Mit Eval <br /> Approved By: _'()k Date: S 151 z3 ,,,,,, t, J Site Work or Drainage Proposed <br /> 4-f 11`���"�, .-A• <br /> '►+� I_ ,_,� ❑n al, Prevention for high hazard: <br /> I ,y�,, w,vry Q�jVil`� (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT Ric rn supportive housing) <br /> Separate/Deferred Submittals Required: cirRoute 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: 0 See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required (Permit#: PW 24—®Z <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder Lon 1% (‘t.,� <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 /> ELECTRICAL/PLUMBING Additional Notes: N rGj Uzi ,gi <br /> Additional Notes: ib r G{,! / �111 <br /> Approved By: Date: Approved By: 4-e Pr tx( nN Dat 1-/Z / Z 5 <br /> yiimivvek. OrAliwt, b/is 112v23 <br />