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,intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �p93 0.5 — 0 "' <br /> BUILDING MN1 _ANNING ad/-T ,- <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ,,,,g..-►fj <br /> Overlay/Agreement -- <br /> ❑ Route to Commercial Building Nonresidential Use ...s" ,¢ <br /> ❑ Route to Residential Building Residential Use ye p <br /> ❑ Make this a"IN"Permit Proposed No. of Dwelling Units: i <br /> Bidg/TI/Addn/Rem Size [7 77 Total No.of Dwelling Units: / <br /> Garage/Accessory Struct.Size (. I I Planning/Landscape Inspection Required before Final?laYes ❑No <br /> Number of Stories ��,,__,,// Zj "In Lieu"Fee:Type: �--. Amount$,l'- <br /> Basement t2 No ❑Yes, Fin I Unfin School Impact Fee: Total $ 1/// �Gt' <br /> Type of Construction 'Zpc. Calculated: N I% Credit: -'- <br /> Occupancy Group 74( DEverett School Dist IRMukilteo School Dist <br /> Occupancy Load Z Park impact Fees for permits applied for after'1/1/2022: <br /> Fire Sprinklers: ❑Update Existing'%'i ew System lNot.Req'd Park Impact Fee Total$frie ° (net due after credit for existing uses) <br /> Reason Sprinklers Required: AIN,lt+ d . Fee Schedule Used For Calculation(Year): c,24 23 <br /> Fire Alarm: ❑Update Existing ❑New System Vot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit-issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 112/, ,//No LI 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add(RCW 64.55 docs required prior to final? ❑Yes )�INo El0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$a�Q 2O Additional Notes: <br /> OIL R (e.Aet Approved By: 'Date: /v -7--2,— 2...7 <br /> PUBLIC WORKS , <br /> Additional Notes: . Intake OK by: Date: <br /> Intake Comments; PW Worksheet Needed if <br /> r"��l ❑Sys Dev Eval(Util/sW)❑Traffic Mit Eval <br /> " <br /> Approved By; 1 ,..— Date: I(V). /Z� DSite Work/Drainage EAddress Letter <br /> , ❑Backfiow 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 lie A rm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> This Permit is Approved by Public Works <br /> Fire Dept.Fees: El See PW Review Worksheet and associated attached items <br /> Elrr <br /> Review of As-Built Plans-NO FiRE FEE I E A Separate PW Permit is Required(Permit#: PW 22 6 S.022) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> 0-Review/inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved 13y: ,�C'ar v 6\ Date: c3.- .Z 3 IX Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> c c2 sg-3 0 Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING • Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By. - _ '� Date: 5 fi7 I 2-o13 <br />