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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 3-3 O Lt-'0�x <br /> BUILDING PL1'—IG /AI IT • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> • <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 (( Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement EiNo ❑Yes, Fin I Unfin School Impact Fee: Total $ 1 i J I'4 <br /> Type of Construction /2._.<- Calculated: /J) 3' /r'' Credit: <br /> Occupancy Group i ❑Everett School Dist 13Klukilteo School Dist <br /> Occupancy Load �/ Park Impact Fees for permitsc�alied for after'U1/2022: <br /> Fire Sprinklers: ❑Update Existing L�/INew System ❑Not•Req'd Park Impact Fee Total$ 3(Ov (net due after credit for existing uses) <br /> Reason Sprinklers Required: `7l , "f Fee Schedule Used For Calculation(Year): c� UZ-J <br /> Fire Alarm: ❑Update Existing ❑New System C+ 'Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <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 g No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add]AMU 64.55 does required prior to final? ❑Yes L No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3/1;i LcD Additional Notes: <br /> • <br /> Approved By: � ' ate: ri/,/03 <br /> PUBLIC WORKS • • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(UtiiISW)❑Traffic Mit Eval <br /> Approved By: J7p c Date:. 7//4/ k DSite 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: El Route this folder for PW Review at end --PW Review Worksheet <br /> Ig 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 /> El This Permit is Approved by Public Works <br /> Fire Dept.Fees: IS See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE El A Separate PW Permit is Required(Permit#: P14 O5--Oa3 ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> a Review/Inspection Scope ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit Issuance) <br /> Approved By:�J kycdv,, Date: J.(. _ \ gWIII be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope--PW Not Required <br /> ELJCTRICA,LII?LUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: ,a7�13 Date: s[ii 12VZ <br />