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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# i> 0'1— oCgq <br /> BUILDING PLP MG lil N fr ,4 <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> El Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> 0 Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size (7z7 S(= Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4(/ S(= PIanning/Landscape Inspection Required before Final? ❑Yes CINo <br /> Number of Stories 3 "in Lieu"Fee:Type: Amount$ <br /> Basement rgNo DYes, Fin 1 Unfin School Impact Fee: Total $ // d' <br /> Type of Construction 1ge_ J <br /> Calculated: /, g C/4' Credit: <br /> Occupancy Group ti ❑Everett School Dist dciMukilteo School Dist <br /> Occupancy Load `e Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers:❑Update Existing ffNew System ❑Not Req'd Park impact Fee Total$ '/1O (net due after credit for existing uses) <br /> Reason Sprinklers Required: 7h' 5-j Fee Schedule Used For Calculation(Year): Z�Z3 <br /> Fire Alarm: ElUpdate Existing ONew System Oklot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: El Yes El 100%Credit_Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet req'd for permit? DYes t No ❑ 50%Credit-Issued 0/3/2022-6/2/2023 <br /> Adel RCW r�II 64.55 dacs required prior to final? CIYes l�d No El 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3/c; Ct ZO Additional Notes: <br /> Approved By: Date: 7/r`te.7 <br /> . . PUBLIC WORK <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed If: <br /> DSys Dev Eva!(Util/Sw)❑Traffic Mit Eval <br /> Approved 13y: ��,��, /'�'„ Date: 7//7/ ; Mite Work/Drainage DAddress Letter <br /> /"' %4��'"` (` l ❑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 /> `giFire Sprinklers ❑Fire Alarm Other: EIThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND Create Green Folder ®Submitted Previously ❑Deferred <br /> tS!This Permit is Approved by Public Works <br /> Fire Dept.Fees: EL See PW Review Worksheet and associated attached items <br /> Q Review of As-Built Plans-NO FIRE FEE XA Separate PW Permit is Required(Permit#:PW Qg0S-022 ) <br /> El Minimal or No Fire Scope-NO FiRE FEE AND 0 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 /> V.,Approved By: yV w n Date: 4/._I)23 Jul Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> 0 Public Works has no scope---PW Not Required <br /> ELECTRICAL/KUNMIiNG Additional Notes: <br /> Additional Notes: -� <br /> Approved By: Date: Completed By: `� �L. Date: sill\10 <br />