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Intake &Approval Sheet (F(�I I ERMIT STAFF ONLY) PERMIT# 6?3-0Cf —. c' 7 <br /> BUILDING 'u PLAEF— USN( T e <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 /> Bidg/TIiAddn/Rem Size I7.2-F-SP _ Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4(f SF Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories 3 "in Lieu"Fee:Type: Amount$ <br /> Basement iallo ❑Yes, Fin!Unfin School Impact Fee: Total $ l//cet/ <br /> Type of Construction //2C Calculated: // ��� Credit: dta— <br /> Occupancy Group `r ❑Everett School Dist tgidlukilteo School Dist <br /> Occupancy Load ��,,// '€ Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: ❑Update Existing ll4New System ❑Not.Req'd Park Impact Fee Total$ 3/fa (net due after �diitfor existing uses) <br /> Reason Sprinklers Required: 1�' .?-t- Fee Schedule Used For Calculation(Year): J <br /> Fire Alarm: ❑Update Existing ❑New System 121Not Req'd Permit Technician Use Only:Apply Phase-in Credit Per EMC49.53.200 <br /> Reason Fire Alarm Required: r-1 El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet req'd for permit? Dyes � 'No CI 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I ROW 64.55 does required prior to final? ❑Yes LldNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Z/S, q2..o Additional Notes: <br /> Approved By: A (/ ate: 4--03 <br /> PUBLIC WORKS • f • • ' • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed it <br /> I_ISys Dev Eval(Util/sW) ❑Traffic Mit Eval <br /> Approved By:yancetAl ✓Date: 7//7 2 DSite Work/Drainage EIAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT . supportive housing) <br /> Separate 1 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 /> • <br /> • <br /> This Permit is Approved by Public Works <br /> Fire Dept.Fees: 'RI See PW Review Worksheet and associated attached items <br /> ❑Review of As-Built Plans-NO FIRE FEE ig A Separate PW Permit is Required(Permit#:PW o a 5 O VL ) <br /> ❑Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> RI-Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: 1a cow,. Date: ‘.„/—1/__23 g Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope--PW Not Required <br /> EL CT.RICAL/RLU1111BING • Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: EJ Date: 5\1\\2023 <br />