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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# a JO(.� — 0Oo2 <br /> BUILDING • •INNING &03—a4 <br /> Intake OK by: Date: Intake OK by: Assign To: Date: �w <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> D Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> D Make this a"W"Permit Proposed No.of Dwelling Units: <br /> BldgITI/AddnlRem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning!Landscape Inspection Required before Final? DYes ONo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement No DYes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: • <br /> Occupancy Group DEvereft School Dist DMukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers:DUpdate Existing DNew System DNot 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: DUpdate Existing DNew System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: t-i t1n--r El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet req'd for permit? DYes !�t No ❑ 50%Credit-Issued 9/3/2022 -6/2/2023 <br /> Add!ROW 64.55 dots required prior to final? ❑Yes ❑No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Additional Notes: <br /> Approved By: Date: <br /> PUBLIC WORKS • • • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> DSys Dev Eval(Util/SW)❑Traffic Mit Eval <br /> Approved By: Date: OSite Work/Drainage DAddress Letter <br /> ❑Backfiow 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 /> DFire Sprinklers ❑Fire Alarm DOther: DThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND DCreate Green Folder OSubmitted 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 D A Separate PW Permit is Required(Permit#: PW ) <br /> D Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> VI-Review/Inspection Scope ADD FIRE FEE D is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: ,&o Lijy> Date: L j..'1 -_23 D Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> D Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: • Date: <br />