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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 13,2.3j f-( 05 , <br /> BUILDING <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 /> Bidgrfi/Addn/Rem Size !7�7 SF' Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4 (( 5P- Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories 3 "In Lieu"Fee:Type: Amount$ <br /> Basement �No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction liz C.- Calculated: // cS/'o Credit: <br /> Occupancy Group -/ ❑Everett School Dist Jlukilteo School Dist <br /> Occupancy Load Park Impact Fees for permi applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing L1QNew System ❑Not'Req'd Park Impact Fee Total 0 (net due after cr it for existing uses) <br /> Reason Sprinklers Required: Tfrt s—( Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ONew System ®Not Req'd Permit Technician Use Only:Apply Phase-in Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit-issued 1/i/2022-9/2/2022 <br /> ROW 64.55 MF vvorksheet req'd for permit? DYes ON_ <br /> j jo ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes gNo ❑ 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3/5;9 ,o Additional Notes: <br /> Approved By: , -�_-—mate: 7//Y—Z3 <br /> PUBLIC WORKS <br /> • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(UtillsW)OTraffic Mit Eval <br /> Approved By%/ /�n,� Date: 7/9/ .3 ❑Site Work/Drainage Address Letter <br /> �1� 1 ❑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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ►4 This Permit is Approved by Public Works <br /> Fire Dept.Fees: Et See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FiRE FEE 121A Separate PW Permit is Required(Permit#: PW 2 Oc O22 ) <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: A- Date: L_/-/) :23 E Will be issued separately(Separate Green Folder,PW issu ead of Bldg) <br /> 0 Public Works has no scope-- PW Not Required <br /> ELi~CTRICALII?LUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: 5\A/2A1L3 <br />