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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (( ' <br /> BUILDING Ask (FOR <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 ( '�,`C Q, <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size `" Total No. of Dwelling Units: <br /> Garage/Accessory Struct.Size — Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Number of Stories rrbb�� "In Lieu"Fee:Type: Amount$ <br /> Basement 181No DYes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction —t}- Calculated: Credit: <br /> Occupancy Group $ DEverett School Dist DMukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: [Update Existing ❑New System Not Req'd Park Impact Fee Total$ (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ZUpdate Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? DYes No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? DYes igNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ lt4:ex0 Additional Notes: <br /> Il/ln/22 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: wL,,tt r -en art-( ( Intake OK by: Date: <br /> w t.d Of-Ft c-g SFAGf , Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/SW) ❑Traffic Mit Eval <br /> Approved By: Arg> Date: /t$ ee ,.?.- ❑Site Work/Drainage ❑Address Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate/Deferred Submittals Required: El Route this folder for PW Review at end ---PW Review Worksheet <br /> El Fire Sprinklers ❑Fire Alarm DOther: ❑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 /> Er Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:‘<i c3,roc.,,,h Date: G/;2,2 7,2,2 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed B jc e, -�'`� " Date: I d/(Z.yt <br />