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-A A- -- _._.. JX 6 A ■ .L_,1.JYjJr Z)I Zjr-r ca11ILY) PERWIT# <br /> BUILDING r' ANNING <br /> A I�— <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 /> Bldg1TI1Addn/Rem Size 2-1,;.3 -r+-i Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Number of Stories "in Lieu"Fee:Type: Amount$ <br /> Basement I(No QYes, Fin/Untiin School Impact Fee: Total $_ <br /> Type of Construction N A Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Z <br /> Park Impact Fees for permits applied for after 11112022: <br /> Fire Sprinklers: Update Existing❑New System ❑Nat Req'd Park Impact Fee Total I (net due after creditfor existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: '�Update Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMG19.53.200y -�- <br /> Reason Fire Alarm Required: ❑ 100%Credit-issued 1/1/2022-9020" <br /> RCW 64.55 MF worksheet req'd for permit? QYes [(No El50%Credit-Issued 9/3/202-2-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? []Yes ©No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total 45—v Additional Notes: <br /> AZ f:�2/o; <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> -------------------------- ----------- --- <br /> Intake Comments: IPWWorksheet Needed lf• <br /> ❑Sys Dev Evai(Uti11sM I]Traffic Mit Eval <br /> Approved By: Date: 5 ,o tv�.'� 'USiteWork/Drainage ❑Address Letter <br /> ❑Backffow Prevention for high hazard: <br /> FIRE I])~PARTMENT (dental,medical,animals,mortuary,hospital, <br /> (dental,medical, <br /> Separate I Deferred Submittals Required: ❑Route this folderforPWReviewatend---PWReviewWorksheet�y ~� <br /> ❑Fire Sprinklers ❑Fire Alarm QOther: ❑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 /> Q Minimal or No Fire Scope-NO FIRE FEE AND ❑ is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE Ells in a Separate Green Folder Uoinwith this folderfor permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑Public Works has no scope--PW Not Required <br /> EL._ECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />