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Intake &Approval Sheet (Fn '.ERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLAID— (,{NI -r <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 /> Bldg/Ti/Addn/Rem Size (22-7 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4/f PlanninglLandscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories 3 "in Lieu"Fee:Type: Amount$ <br /> pp <br /> Basement No ❑Yes, Fin/Unfin School Impact Fee: Total $ // I1# — <br /> Type of Construction is -C. Calculated: /g/1% Cr dit: I <br /> Occupancy Group (R-C ❑Everett School Dist ►-' ukilte School Dist <br /> Occupancy Load ,-� /� Park Impact Fees for permits applie for after 1/1/2022:Fire Sprinklers:❑Update Existing 1-�iNew System ❑Not Req'd Park impact Fee Total$ 3/t G net due after credit for existing uses) <br /> Reason Sprinklers Required: ��'f S '� Fee Schedule Used For Calculation(Year): Z 66 3 <br /> Fire Alarm: ❑Update Existing ❑New System 'Not Req'd Permit Technician Use Only:Apply Phase-in Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: El 100%Credit-issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes }'No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add!ROW 64.55 does required prior to final? ❑Yes 1Io ❑ 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ .3/.�/2-0 Additional Notes: <br /> Approved By: Date: <br /> PUBLIC WORKS • . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW iWorksheet Needed if <br /> ❑Sys Dev Eval(Utii/SW)❑Traffic Mit Eval <br /> Approved By: Date: 77? fz! [(Site Work/Drainage [(Address Letter <br /> / ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate i 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 ❑Submiffed Previously ❑Deferred <br /> 2 This Permit is Approved by Public Works <br /> Fire Dept.Fees: W.See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FiRE FEE A Separate PW Permit is Required(Permit#: PW22o5-0E2- ) <br /> ❑ Minimal or No Fire Scope-NO FiRE FEE AND ❑ Is located in this folder <br /> ta Review/Inspection Scope-ADD FIRE FEE ❑t is in a Separate Green Folder(foin with this Ibiderfor permit issuance) <br /> Approved By: rik QIN Date:L/.` 'lit.Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑Public Works has no scope--PW Not Required <br /> EL.ECT.R1CALiRLUM.BING Additional Notes: <br /> Additional Notes: �Q <br /> Approved By: Date: Completed By: .%T.J-J Date: vr'�k1'UV <br />