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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#b 2362 -° S <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: pat,. <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 t,$(eN.�c Proposed No. of Dwelling Units: <br /> BI•a/TI/A 4dn/Rem Size - of Dwelling Units: <br /> GarAccessory Struct.Size Ianning/Landscape Inspection quired before Final? ❑Yes ❑No <br /> Number of Stories ' J "In Lieu"Fee: Type: Amount$ <br /> Basement ni, o ❑Yes , Fin/Unfin School Impact Fee: Total '. <br /> Type of Construction s Calculated: Credit: <br /> Occupancy Group k ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load_ tO0 D We�6S Park Impact Fees for .ermits applied for after 1/1/2022: <br /> Fire Sprinklers: L I Updatee Existing El New System, Not Req'd Park Impact Fee Total :i (net due after credit for existing uses) <br /> qI Reason Sprinklers R Ped45) Fee Schedule Used or Calculation(Year): <br /> Fire Alarm: Update Existing <br /> .�❑. New System 1'�lot Req'd Permit Technic' use only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Requ red: ❑ 100%Cr:dit Issued 1/1/2022 9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 50% redit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? <br /> // Yes n/\�)\dditio❑ 0°,Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total S (,� ,al Notes: <br /> Approved By: Date: <br /> • PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Nee..d if: <br /> ❑Sys Dev Eval it/SW)ElTraffic Mit Eval <br /> Approved By: , a • 41-12,72) ❑Site Work/D ainage ❑Address Letter <br /> ❑Backflo Prevention for high hazard: <br /> (dental,• edical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supp•'hie housing) <br /> Separate/Deferred Submittals Required: DRoute this folder for PW Review - end ---PW Review Worksheet <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: - ❑This project also has a separ. - concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folde ■Submitted Previously ❑Deferred <br /> ❑This Permit is Approv'd by Public Works <br /> Fire Dept.Fees: 0 See PW Review t,orksheet and associated attached items <br /> ❑ Review of As-B ' fans-NO FIRE FEE 0 A Separate P t, Permit is Required(Permit#:PW___________) <br /> ❑ Minimal or . Fire Scope-NO FIRE FEE AND ❑ Is I. ated in this folder <br /> ADD FIRE FEE 0 I n a Separate Green Folder(join with this folder for permit issuance) <br /> El Revie Inspection Scope <br /> Appro ed By: Date: U ill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Put is Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Ad.' 'anal Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />