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111'tax—e &AppruvaianeeE [runrcmvilrz.1ArrUNl—Y) PERMIT4 <br /> BUILDING DI ANNING -7 <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 /> El Route to Residential Building Residential Use <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> BldgMIAddn/Rem Size Total No. of Dwelling Units: <br /> Garage/Accessory Struct.Size - PIanning/Landscape Inspection Required before Final? ❑Yes E]No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement klNo ElYes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction CalcuIated: Credit: <br /> Occupancy Group Rz ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 3 Park Impact Fees for permits applied for after 11112022: <br /> Fire Sprinklers: QUpdate Existing❑New system ❑Not Req'd Park impact Fee Total$ ""' (net due after crediffor existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> --- -------- ---- ------ ----- ------ -- ----------- ------------- <br /> Fire Alarm: Update Existing ❑New system ❑Not Req'd Permit Technician-Use Only:Apply Phase-In-Gredit Per HMC19.53.200----------- <br /> Reason Fire Alarm Required: r-t El100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? uuYes ❑No ❑ 50%Credit-Issued 9/3/202-2-602023 <br /> Add'I RCW 64.55 docs required prior to final? DYes RINo ❑ 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ ?s o,w pAproved'By <br /> nal otes: <br /> : Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> ---. ------------ ----------- - ----------- <br /> Intake Comments: ;PW Worksheet Needed if- <br /> EISys Dev Eval(UtillSVU)QTraf6c Mit Eval <br /> Approved By: _ Date: C-� USite Work/Drainage ElAddress Letter <br /> 013ackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT ;supportive housing) <br /> _ ---------------- <br /> _ <br /> Separate/Deferred Submittals Required: ❑Route 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 /> 0 This Permit is Approved by Public Works <br /> Fire Dept.Fees, d See PW Review Worksheet and associated attached items <br /> Q Review of As-Built Plans-NO FIRE FEE ❑A Separate PW Permit is Required(Permit#: PW ) <br /> El Minimal or No Fire Scope-NO FIRE FEE AND ❑ is located in this folder <br /> ❑ Reviewl Inspection Scope-ADD FIRE FEE 1❑-t Is in a Separate Green Folder(join with this folderforpermitissuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Q Public Works has no scope--PW Not Required <br /> EL ECTRICALIPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />