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Intake &Approval Sheet As,(FOR PERMIT STAFF ONLY)(1 3°I PERR n)l-r# J?c JQ 2 p r? <br /> BUILDING lir LANNING 6 0 --/9/ <br /> Intake OK by: Date: Intake OK by: Assign To: `,v ` Date: A//1/2-3 <br /> Intake Comments: Intake Comments: <br /> Zone -s <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ElMake this a"IN"Permit - Proposed No.of Dwelling Units: � <br /> Bldg/TI/Addn/Rem Size ara A _ Total No. of Dwelling Units: J <br /> G Accessory Struct.Size cis�- ) Planning/Landscape Inspection Required before Final? DYes giNo <br /> Number of Stories I "In Lieu"Fee:Type: Amount$ <br /> Basement to DYes, Fin/Unfin School Impact Fee: Total $ Ar <br /> Type of Construction - C Calculated: Credit: <br /> Occupancy Group - --G ❑Everett 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 Ca ulation(Year): <br /> Fire Alarm: ❑Update Existing ONew System Mot 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 'Li No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes t§No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Additional Notes: <br /> Approved By: Tic,/� !/ Date: 3/`y/Z`� <br /> IIv�g37o,J ' ! PUBLIC WORKS <br /> Additional Notes: 4+43 j,� AZIAA L Intake OK by: Date: <br /> ' Ma1^'Izi0 0s4 1-'4 Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/sw) ❑Traffic Mit Eval <br /> Approved By: 4 Date: 2/0/'21.51.. Mite Work/Drainage DAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT . supportive housing) <br /> Separate I Deferred Submittals Required: DRoute this folder for PW Review at end ---PW Review Worksheet <br /> ❑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 /> 0 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:\ , aW Date:,,i a/1i El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING dditional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: 4: ' Date: ' Y t! 267;Z <br />