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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1 r; 6 _ <br /> O <br /> 0-Vie <br /> BUILDING • •ANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone g—? <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use 1�' R <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addr Zem Sit 2I 1O S Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories i "In Lieu"Fee:Type: Amount$ <br /> Basement EZINo ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction SP—- Calculated: Credit: <br /> Occupancy Group Sd-C ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load =(2—(-- Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: DUpdate Existing ONew System Ig+Vot*Req'd Park Impact Fee Total$ (net clue after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): _ <br /> Fire Alarm: El Update Existing ONew System ErNot 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? ❑Yes Er No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 32.No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 10 r 0G'm Additional Note <br /> / Li 16171(00 /q tz-2D <br /> Approved By: Date: <br /> PUBLIC WORKS . <br /> Additional Notes: Intake OK by: Date: <br /> 40t--)1„_T T--K1v•tL,' Ake M Intake Comments: PW Worksheet Needed if <br /> • <br /> I,I CREC-T10NS (LUZ•- 3a S D vue .e Ch,Ky ❑Sys Dev Eval(Util/SW) OTraffic Mit Eval <br /> Approved By: (O A Date: -k I 2�I z3 �`eu. '1 /V OSite Work/Drainage OAddress Letter <br /> OBackflow 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 ❑Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate 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 /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope--PW Not Required <br /> ELECTRICAL!RLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: j C_ Date: 7-I r(p r2t)23 <br />