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Intake &Approval Sheet (F PERIUIJT STAFF ONLY) PERMIT# a-3 p [ ( 0 c,i- <br /> BUILDING PLAT=' (,(p.1• <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 /> D Route to Residential Building Residential Use <br /> O Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bidg/TllAddn/Rem Size /7.L7 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4(( Planning/Landscape Inspection Required before Final? OYes DNo <br /> Number of Stories 3 "in Lieu"Fee:Type: Amount$ <br /> Basement 1No DYe's, Fin/Unfin School impact Fee: Total $ ///1/' <br /> Type of Construction ,f Calculated: 1/� C(edi <br /> Occupancy Group ❑Everett School Dist Eg/lukilteo chool Dist <br /> Occupancy Load ( Park Impact Fees for permits applie or after'111/2022: <br /> �-, <br /> Fire Sprinklers:DUpdate Existing C'�New System ❑Not Req'd Park Impact Fee Total$ 3/10 et due after credit for existing uses) <br /> Reason Sprinklers Required: 7 1 , -j Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ®New System I2Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMCI9.53.200 <br /> Reason Fire Alarm Required: i t El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet req`d for permit? DYes !:: No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'l ROW 64.55 docs required prior to final? ❑Yes EINo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ .. /s-, ' W Additional Notes: <br /> Approved By%��a a e•, / - 1? IPUBLIC WOR}`s • . . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Weeded if: <br /> ❑Sys Dev Eval(UtiI/SW) ❑Traffic Mit Eval <br /> Approved By: 'pc., Date: 7/t113, ❑Site Work/Drainage DAddress Letter <br /> ❑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 OOther: EIThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND El Create Green Folder OSubmitted Previously ❑Deferred <br /> ISkThis Permit is Approved by Public Works <br /> Fire Dept.Fees: igSee PW Review Worksheet and associated attached items <br /> D Review of As-Built Plans-NO FIRE FEE A Separate PW Permit is Required(Permit#: PWAo?OS—OR ) <br /> D Minimal or No Fire Scope-NO FiRE FEE AND CI Is located in this folder <br /> EI,Review/Inspection Scope ADD FIRE FEE CI <br /> Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By:�0%vo(AJAN Date: LI —1\29) g Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> D Public Works has no scope--PW Not Required <br /> ELECTRICAL/RLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: 51tAtim <br />