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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0 a2-30 4.- oqg <br /> BUILDING PLf, —IG (Ai 1 Y G <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 (72 7 .S Total No.of Dwelling Units: _ <br /> Garage/Accessory Struct.Size 4 ( ( SF PlanninglLandscape Inspection Required before F' al? DYes ❑No <br /> Number of Stories 3 "In Lieu"Fee:Type: Amotin $ <br /> Basement INo ❑Yes, Fin/Unfin School Impact Fee: Total $ /e. 1V <br /> Type of Construction kC Calculated:. / . Y6 Credit: "�— <br /> Occupancy Group `i ❑Everett School Dist atlukilteo School Dist <br /> Occupancy Load Park Impact Fees for permmitsbpplied for after 1/112 22; <br /> Fire Sprinklers: ❑Update Existing LlNew System ❑Not.Req'd Park Impact Fee Total$ 3/S (net due after credi for existing uses) <br /> Reason Sprinklers Required: 7 fi' s-- - Fee Schedule Used For Calculation(Year): a 4 Z-3 <br /> Fire Alarm: DUpdate Existing ❑New System E 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 /> i-� <br /> RCW 64.55 MF Worksheet req`d for permit? DYes l 'No ❑ 50%Credit-Issued d/3/2022-6/2/2023 <br /> Add!RCW 64.55 docs required prior to final? DYes EUf io El 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3f s 42...O Additional Notes: <br /> Approved By: Bate: �� f2yJ <br /> • Pu LIG WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed it: <br /> ❑Sys Dev EvaI(Util/SW) ❑Traffic Mit Eval <br /> Approved By:,a,ryaa Date: 77/7/Z_3 OSite 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 /> . ire 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 /> N This Permit is Approved by Public Works <br /> Fire Dept.Fees: IR See PW Review Worksheet and associated attached items <br /> ❑Review of As-Built Plans-NO FIRE FEE tilA Separate PW Permit is Required(Permit#:PW2ROS-01.2. ) <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 By:Ng.,tleyv p LA Date: ei //—23 K Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑Public Works has no scope--PW Not Required <br /> EL.ECTRICALIPLUMBIIVG Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: A Date: 61 AVy1,5 <br />