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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#S301,30 C—f o3g <br /> BUILDING = PLC-SIG vtv IT— A <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 /> ElRoute to Residential Building Residential Use r <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> BIdg/TI/Addn/Rem Size 0 27 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4.4 ( Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories 3 "In Lieu"Fee:Type: Amount$ <br /> Basement inNo ❑Yes, Fin/Unfin School Impact Fee: Total $ pi/ 1/0, <br /> Type of Construction `12-C- Calculated: // 4xC(, Credit: GO' <br /> Occupancy Group /k•C, ❑Everett School Dist ,iMukilteoSchool Dist <br /> Occupancy Load I f O./ Park Impact Fees for permits applied for after'i/112022: <br /> Ll Fire Sprinklers:❑Update Existing New System ❑Nofi Req'd Park Impact Fee Total$ y/456 (net due after credit for existing uses) <br /> Reason Sprinklers Required: I/l S-f- Ubtl e f Fee Schedule Used For Calculation(Year): 2 is <br /> Fire Alarm: ❑Update Existing ❑New System Mot Req'd Permit Technician Use Only:Apply Phase-in Credit Per EMC49.53.200 <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 'No El50%Credit-Issued 0/3/2022-6/2/2023 <br /> Add'I RCW 64.55 dots required prior to final? ❑ rYes l k1 No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3,/f) gap Additional Notes: <br /> Approved By: bate: 7 /c&-Z3 <br /> PUBLIC WORKS • ' ' <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed If!' <br /> 7.23 <br /> OSys Dev Eval(Util/sW) ❑Traffic Mit Eval <br /> Approved By: ) ,�,. Date: 'ilk ❑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: ❑Route 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 OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> This Permit is Approved by Public Works <br /> Fire Dept.Fees: iiii See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE ► A Separate PW Permit is Required(Permit#: PW2g0 -OV2 ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved I3y:.., u m Date: y -ill -I3 fgrWill be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> ❑Public Works has no scope PW Not Required <br /> ELECTRICALImLUIVIBING . Additional Notes: <br /> Additional Notes:Approved By: Date: Completed By: cit3 ��Ii <br /> Date: I1 I'2o2-3 <br />