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XXXLu LxJ-iJJPXvva1 ­311vut Ir-Ls.ix r-j--ruv►.II a1dgrt- LjiVLy) PERMIT��,� -r eo L <br /> SUILDING ANNING L-b G- .5 <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/TIIAddn/Rem Size `, 4 ' Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size PlanninglLandscape Inspection Required before Final? ❑Yes []No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement No ❑Yes, Fin I Unfn School Impact Fee: Total $ <br /> Type of Construction YPC Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 11112022: <br /> Fire Sprinklers: '❑Update Existing ❑New System ❑Not-Req'd Park Impact Fee Total$ "', (net clue after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> ------------------------------------------ ------------------------------------ <br /> Fire Alarm: WUpdate Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: rr�t� El100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? MYes ❑No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'1 RCW 64.55 docs required priorto final? ❑Yes 91No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 2-5 0-c" Additional Notes- <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: n��, �Er+,, Intake OK by: Date: <br /> ------------------------- --------------- <br /> Intake Comments: IPWWorksheetNeededrf <br /> l_lSys Dev Evaf(UtiUSW) ElTrafffc Mit Eval <br /> Approved By: ` - Date: 5 t� 'USite Work/Drainage llAddress Letter <br /> ;C1Backffow Prevention for high hazard: <br /> FIRE DEPARTMENT (dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> - -- <br /> Separate I Deferred Submittals Required: ❑Route this folder for PW Review at end---PW Review iNorksheet <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: ❑This 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: ❑See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE ❑A Separate PW Permit is Required(Permit#. PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> ElReview/Inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder Goin with this folderforpermitissuance) <br /> Approved)3y: Date: ❑Will be issued separately(separate Green Folder,PW Issued ahead of Bldg) <br /> ❑Public Works has no scope—PW Not Required <br /> ELJECTRICALIPLUMBING- Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />