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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2-`1)' 007 <br /> BUILDING • "PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: )y.l` _ _�_ � _ <br /> Zone �l 14 "2 <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/TI/Addn/Rem Size 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 to ❑Yes , Fin/Unfin ' School Impact Fee: Total $ <br /> Type of Construction —5 Calculated: Credit: <br /> Occupancy Group /I 5 f-/ ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for . . /2022: <br /> Fire Sprinklers: Update Existing ONew System ❑Not Req'd Park Impact Fee Total$ <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Ye. : _, <br /> Fire Alarm: Alpdate Existing ❑New System ❑Not Req'd Permit Technicians:Apply Credit P•r EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/20 -9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 12 No 0 50%Credit-Issued 9/3/ 422-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 9 No 0 0%Credit-Issued 6/ /2023 or later I <br /> VALUATION CALCULATION: Total$ ri DoO, o� Additional Notes: no h.p fi e5 c0.Q <br /> Approved By: Date: ID q �� <br /> P LIC WORKS n n <br /> Additional Notes: Intake OK by:_-9 _ Date: 'O l V G0 7� <br /> Intake Comments: PW Worksheet Needed if. <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Approved B ' )/ Date:(f/ /ie.'L Mite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate!Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> ❑Fire Sprinklers OFire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: A/or4A, to AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> 0 This Permit is Approved by Public Works <br /> Fire Dept. Fees: 0 See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#: PW ) <br /> 0 Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder ' <br /> ❑ Review/Inspection Scope-ADD FIRE FEE/l 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By,) Date:,/'/ ,p4Z.t 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ```��' ��jjj / 110 Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes:lowitAvnote I6 In-' �- <br /> Additional Notes: �l <br /> Approved By: Date: Approved By: Date: <br />