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Intake &Approval Sheet (Riff PERMIT STAFF ONLY) PERMIT# OW( <br /> BUILDING PLAA�` ,(Nit T 'p <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 /> ❑ Route to Residential Building Residential Use <br /> El Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/Tl/Addn/Rem Size I72 7 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4 I I PIanning/Landscape Inspection Required before Fin I? DYes ❑No <br /> Number of Stories "In Lieu"Fee:Type: Amount <br /> Basement VNo DYes, Fin/Unfin School Impact Fee: Total $ / /k <br /> Type of Construction / Calculated: c Crre : <br /> Occupancy Group •i ❑Everett School Dist ukilteo chool Dist <br /> Occupancy Load Park Impact Fees for permits applie for after 1/1/2022: <br /> Fire Sprinklers:❑Update Existing MNew Systen. Not Req'd Park Impact Fee Total$ 3/JO ( et due after credit for existing uses) <br /> Reason Sprinklers Required: T A/ S-(- Fee Schedule Used For Calculation(Year): 7(72,3 <br /> Fire Alarm: DUpdate Existing ®New System IgrNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.63.200 <br /> Reason Fire Alarm Required: �-�/ El 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'1 RCW 64.55 dots required prior to final? DYes 12I<Io ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3is,cO Additional Notes: <br /> Approved By: Date: <br /> • <br /> ' PUBLIC WORKS • • • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments; PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Utii/SW) DTraffic Mit Eval <br /> Approved By; �'7�� Date: 7//9/3 Mite Work/Drainage C(Address Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> •FIRE DEPARTMENT supportive housing) <br /> Separate/Deferred Submittals Required: DRoute this folder for PW Review at end --PWReview Worksheet <br /> 'Fire Sprinklers ❑Fire Alarm Other: EIThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND 0Create Green Folder ❑Submitted Previously ❑Deferred <br /> .This Permit is Approved by Public Works <br /> Fire Dept.Fees: RSee PW Review Worksheet and associated attached items <br /> Review of As-Built Plans-NO FIRE FEE ftA Separate PW Permit is Required(Permit#: PW2205-O ) <br /> Minimal or No Fire Scope-.NO FIRE FEE AND ❑ 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 13y:�',bcoWe‘ Date: ' I,l\- , ErWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Q Public Works has no scope---PW Not Required <br /> ELECTRICAL/KUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: c Date: Si11'T?� <br />