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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (3®l-?0 q— 07 <br /> BUILDING PLP—G bid ¢ q✓ <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 C 7 2.7 SP Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4 j ( SSI= PlanninglLandscape inspection Required before Final DYes ONo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement J'No DYes, Fin!Unfin School Impact Fee: Total $ � • <br /> Type of Construction /R e Calculated: // gy67 Cr-'it: <br /> Occupancy Group ❑Everett School Dist Gi ulukilt=• School Dist <br /> Occupancy Load Park Impact Fees for permits appli•d for after 1/1/2022: <br /> ��--yy <br /> Fire Sprinklers:❑Update Existing LYlNew System DNot Req'd Park Impact Fee Total', /i O (net due after credit for existing uses) <br /> le <br /> Fee Schedule Used For Calculation ear <br /> Reason Sprinklers Required: � $'�' � (Year): <br /> Fire Alarm: Update Existing ONew System E1Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: El Yes El 100%Credit-issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet req'd for permit? ❑Yes LI No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 does required prior to final? DYes ErNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3/5-f q2 0 Additional Notes: <br /> • <br /> Approved By: Date: 7--e-ey <br /> PUBLIC woRRs . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> DSys Dev Eval(Util/sW) OTrafflo Mit Eval <br /> Approved By: mistA Date: 77043 DSite Work/Drainage DAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> •FIRE DEPARTMENT supportive housing) <br /> Separate I Deferred Submittals Required: DRoute this folder for PW Review at end --PW Review Worksheet <br /> sire Sprinklers QFire Alarm ❑Other: ®This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND EICreate Green Folder ['Submitted Previously ❑Deferred <br /> • This Permit is Approved by Public Works <br /> Fire Dept.Fees: RI See PW Review Worksheet and associated attached items <br /> Review of As-Built Plans-NO FIRE FEE RA Separate PW Permit is Required(Permit#:PWR9QS-OZZ, ) <br /> El Minimal or No Fire Scope-NO FIRE FEE AND d Is located in this folder <br /> .Review/Inspection Scope-ADD FIRE FEE ❑(la in a Separate Green Folder(join with this folder for permitissuance) <br /> Approved By: ‘iY-®�yLot Date: Li—/'^-�3 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope --PW Not Required <br /> ELECTRICAL/'LUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: 0 Date: S\11�turti <br />