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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# S2)205- Ott?... <br /> • •LANNING <br /> P <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone LI <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use of p I i . fat, <br /> ElRoute 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 j "In Lieu"Fee:Type: Amount$ <br /> Basement No ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction tll Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load oL Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: y Update Existing ❑New System ❑Not Req'd Park Impact Fee Total$ / <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: Update Existing ❑New System El Not Req'd Permit Technicians:Apply 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? ❑Yes 12 No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes I No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ -'S c) D Additional Notes: <br /> ' ' ia-0 5/ /n <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: IPW Worksheet Needed if: <br /> l❑Sys Dev Eval ❑Traffic Mit Eval <br /> Approved By: Date: �l p�?o� €❑Site Work or Drainage Proposed <br /> 1 €❑Backflow Prevention for high hazard: <br /> i(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 ❑Fire Alarm ❑Other: ❑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: 0 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 /> E Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Kt BIpt, )Y7 Dater23a3 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> lAPublic Works has no scope--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: v5 1 rl t'lo L j <br /> Approved By: Date: Approved By. Date: <br />