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intake 64 Approval meet (rut( .1`'1t(1Vi1 l < -1 All— UNLY) PERMIT# i..5 f�`'o(() 14,— Qc— <br /> BUILDING `,NNING (20/1,S,Q1IS r,z <br /> Intake OK by: Date: Intake OK by: Assign To: Date: v,t 11 <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 /> 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 $ .....,e _ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist I <br /> Occupancy Load Park Impact Fees for s lied for after 1/112022: if2R- <br /> r <br /> Fire Sprinklers: ❑Update Existing ONew System ❑Not'Req`d Park Impact Fee Total (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used r Calculation(Year): c2C)Z <br /> Fire Alarm: DUpdate Existing ONew System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMCI9.53.200 <br /> Reason Fire Alarm Required: El Yes El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet reg'd for permit? I�Yes 0 No 0 50%Credit-Issued 9/3/2022-6/2/2023 U \ c, <br /> Add'1 ROW 64.55 dots required prior to final? ❑Yes ❑No El0%Credit-Issued 6/3/2023 or later �r' l y <br /> VALUATION CALCULATION: Total$ Additional Notes: <br /> Approved By: / Date: /` 1 —l <br /> PUBLIC WORKS . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/sW) [(Traffic Mit Eval <br /> Approved By: Date: / 1 2-mQ... ❑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 <br /> �FSubmittals Required: ❑Route this folder for PW Review at end --PW Review Worksheet <br /> ' Fire Sprinklers .Iire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> 0 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 it: PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> pet n S ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Ere,t,.✓Y, Date: Lf__2 ^s, ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope--PW Not Required <br /> ELECTRICAL/PLUMING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />