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Intake &Approval Sheet (F ER.MIT STAFF ONLY) PERMIT# <br /> BUILDING PLAT' (AN Q T • 6 <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 /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size 172_7 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4/( PIanning/Landscape Inspection Required before Final ❑Yes ❑No <br /> Number of Stories 3 "In Lieu"Fee:Type: Amount$ <br /> Basement RrNo ❑Yes, Fin/Unfin' School Impact Fee: Total $ /1/j ('I' <br /> Type of Construction ( -C- Calculated: f 1, 4/ ' redit: -� <br /> Occupancy Group `1 DEverett School Dist lluki eo School Dist <br /> Occupancy Load ,,.--,,// Park Impact Fees for permits p I ed for after'U t12022: <br /> Fire Sprinklers: ❑Update Existing 7�Wew System ❑Not'Req'd Park Impact Fee Total$ J/p (net due after credit for existing uses) <br /> Reason Sprinklers Required: T sf Fee Schedule Used For Calculation(Year): i,2 d Z 3 <br /> Fire Alarm: El Update Existing ❑New System ! 'Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC49.53.200 <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? ❑Yes No Ei 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I ROW 64.55 does required prior to final? ❑Yes rallo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3/S; ILO Additional Notes: <br /> Approved By: Date: <br /> P•UlaLIC WORKS . . . . . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(util/slot) OTraffic Mit Eval <br /> Approved By: /�c' . Date: '//4/23. ) Mite 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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> This Permit is Approved by Public Works <br /> Fire Dept.Fees: FL4 See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE KA Separate PW Permit is Required(Permit It: PW2gOS-0`LZ ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> VI Review/Inspection Scope-ADD FIRE FEE ❑l Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By. ,['(x j p <br /> Date: —`,� J 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: <br /> Additional Notes: <br /> Approved By: Date: Completed By: AA Date: 5111 kj025 <br />