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Intake & Approval Sheet FOR PERMIT STAFF ONLY) PERMIT# - U 3-04".J <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone /,Z' Z <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> O Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: -- <br /> Bldg/TI/Addn/Rem Size 186 oa.4 4I Total No. of Dwelling Units: <br /> r <br /> Garage/Accessory Struct. Size — Planning/Landscape Inspection Required before Final?, Yes ❑No <br /> Number of Stories t "In Lieu"Fee:Type: ,,-/ Amount$ <br /> Basement RINo DYes , Fin/Unfin School Impact Fee: Total $ /1/‘4 <br /> Type of Construction V?:=, Calculated: Credit: .' / <br /> Occupancy Group 'ff==., 7- 1 ❑Everett School Dist ❑Mukilteo School Dist sy/' I <br /> Occupancy Load �yry, Park Impact Fees for permits applied of after 1/1/2022:�r�e►�/ G <br /> Fire Sprinklers: ❑Update Existing ISINew System ❑Not Req'd Park Impact Fee Total$ 3 4 Ohs 3 i <br /> / t cd y <br /> Reason Sprinklers Required: ''Co aoo 4-4-1- Fee Schedule Used For Calculation(Year): ?CU2,2 <br /> Fire Alarm: ❑Update Existing INew System ❑Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: o=1:34---4 `' ❑ 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'I RCW 64.55 docs required prior to final? DYes PilNo 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$_ ti #---i-91 4472.,40 Additional Notes: <br /> (2cpoo`) t Es t = 3,6,9.opc, 0 J <br /> l.ktoco,0►24) (�*�) -- Ito/0432-8 ApprovedBy:� <br /> // <br /> :./Zi 'z3 <br /> (1"114-,z437-8) PUBLIC WORKS <br /> 5!-kGu aw <br /> ay ;way t S; 4(,4fo;t..40 <br /> Additional Notes: ‘:5-NE_l- Gill-`-j e.AA•a tic'rzo.1 Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Approved By: -" , Date: �j�g DSite Work or Drainage Proposed <br /> r DBackflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT :supportive housing) <br /> Separate/Deferred Submittals Required: DRoute this folder for PW Review at end ---PW Review Worksheet <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: OThis 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: tirSee PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE I A Separate PW Permit is Required (Permit#: PW 2 ZO 5- 61 $') <br /> �yTW2z.;. ntJ' <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder A-r.rw&NCp <br /> E1 Review/Inspection Scope-ADD FIRE FEE V-Is in a lder(join with this folder for permit issuance) <br /> Approved By: i(t?(6(A)(\ Date: e-02..„8 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved Byj� ( _-- -Date: 7/_ tie,c A <br /> I ` <br />