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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT 4 oc e = o L fly' <br /> BUILDING PLP G (,(m <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> El 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 /> Bidg/Ti/Addn/Rem Size I 72_7 S Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4 ( ( S''= Planning/Landscape Inspection Required before Final? DYes ONo <br /> Number of Stories 3 "in Lieu"Fee:Type: Amount$ <br /> Basement Lo [(Yes, Fin/Unfin School impact Fee: Total $ /f fr� <br /> Type of Construction //ZC Calculated: // /� Credit: -`9— <br /> Occupancy Group -i ❑Everett School Dist DMukilteo School Dist <br /> Occupancy Load t, Park Impact Fees for permits applied for after'I1112022: <br /> Fire Sprinklers: OUpdate Existing Mew System ❑Not'Req`d Park Impact Fee Total$ 3� (net due after credit for !sting uses) <br /> Reason Sprinklers Required: I �f- Fee Schedule Used For Calculation(Year): C Z, <br /> Fire Alarm: OUpdate Existing ❑New System gNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMCI9.53.200 <br /> Reason Fire Alarm Required: El Yes <br /> Credit-issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req`d for permit? DYes prNo ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'RCW 64.55 docs required prior to final? DYes )'No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ -j/S %J Q Additional Notes: <br /> • <br /> Approved By:A <br /> PUBLIC WORKS . . . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed If: <br /> [(Sys Dev Eval(Util/SW)['Traffic Mit Eval <br /> Approved B...y],aangr,v Date: 770/23 1 ['Site Work/Drainage ['Address Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE Di~PARTMBNT supportive housing) <br /> S rate/Deferred Submittals Required: ❑Route this folder for PW Review at end --PW Review Worksheet <br /> Jpaire Sprinklers ❑Fire Alarm Other: DThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND EICreate Green Folder ❑Submitted Previously ❑Deferred <br /> Ri This Permit is Approved by Public Works <br /> Fire Dept.Fees: 5'See PW Review Worksheet and associated attached items <br /> Q Review of As-Built Plans-NO FIRE FEE EL A Separate PW Permit is Required(Permit#:PWa20S'OZZ ) <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: t 3 a m Date: LI I `�'3 Will be issued separately(Separate Green Folder,PW isa uadahead of Bldg) <br /> ❑Public Works has no scope--PW Not Required <br /> ELECTRICALI(?LUMBING Additional Notes: <br /> Additional Notes: y <br /> Approved By: Date: Completed By: �5� Q� Date: 51 l�\`L113 <br />