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Intake &Approval Sheet (Fj I I PERMiIT STAFF ONLY) PERMIT# ig�3 0 — C9 50 <br /> BUILDING 1 PLA _G ( !T' <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 /> El Make this a"W"Permit Proposed No.of Dwelling Units: <br /> BIdg1Tl/Addn/Rem Size /727 SF Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size ( ( SF Planning/Landscape Inspection Required before F' al? ❑Yes ❑No <br /> Number of Stories 3 "in Lieu"Fee:Type: Amou $ <br /> Basement JNo ❑Yes, Fin!Unfin School Impact Fee: Total $ /// M <br /> Type of Construction iI26 Calculated: i// sy6, I Credit: <br /> Occupancy Group '/ ❑Everett School Dist ukilteo Scho Dist <br /> Occupancy Load ,-,/ -i Park Impact Fees for permits applied for ter 1l112022: <br /> Fire Sprinklers:❑Update Existing I-7New System ❑Not Req'd Park Impact Fee Total$ 3/yo (net a after credit for existing uses) <br /> Reason Sprinklers Required: 7 ft . - Fee Schedule Used Far Calculation(Year): Za 23 <br /> Fire Alarm: ❑Update Existing ONew System PrNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: CI100%Credit-issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF vvorksheet req`d for permit? DYes 12 No ❑ 50%Credit-Issued d/3/2022-6/2/2023 <br /> Add'I RCW 64.55 does required prior to final? oyes al. ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3/1-�/Z0 Additional Notes: <br /> Approved By: Date: 7_,/j9,e,3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/SW)DTraffic Mit Eval <br /> Approved By: 7724y1y0",„a Date: 7`'7/23 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: ❑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 El Create Green Folder ❑Submitted Previously ❑Deferred <br /> 54 This Permit is Approved by Public Works <br /> Fire Dept.Fees: S.See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE fl A Separate PW Permit is Required(Permit#:PWag0S-- ) <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:\(.. ibTa )h Date; ./...'l 3 IS(Wili be issued separately(Separate Green Folder,PVV issued ead of Bldg) <br /> ❑Public Works has no scope--PW Not Required <br /> ELECTRICAL/I?LUMBING . Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: �j\l\`rj,ft3, <br />