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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # <br />BUILDING <br />intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldgrll/Addn/Rem Size <br />4 <br />Garage/Accessory Struct. Size <br />— <br />Number of Stories <br />Basement <br />9 No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />i3 <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System t4Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: RUpdateEAsting ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 29 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes MNo <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: 11WDate: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required- <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review inspection Scope -ADD FIRE FEE <br />Approved By: Date: ,2, j �23 <br />EL,I;CT ICA,LIRLUMBING <br />Additional Notes: <br />Approved By: Date: <br />ANNiNG <br />Intake OK by: Assign To: J2SS Date: 512 <br />Intake Commen s: <br />Zone <br />MO <br />Overlay/Agreement <br />N /A <br />Nonresidential Use <br />Re4a 1 t sery <br />Residential Use <br />tit !A <br />Proposed No. of Dwelling Units: <br />— <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes .ONo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 0 <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukiiteo School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park Impact Fee Total $ ® (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />..................................................................... ----------- <br />Permit Technician Use Only: Apply Phase -in Credit Per EMC19.53.200 <br />❑ 100% Credit- issued 1/1/2022 - 9/2/2022 <br />❑ 50% Credit - Issued 9/3/2022 - 6/2/2023 <br />❑ 0% Credit - Issued 6/3/2023 or later <br />Additional Notes: <br />Approved By: Date: 5 /3123 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />---------------------------- ------------- <br />Intake Comments: IPW Worksheet Needed if. <br />❑Sys Dev Eval (util/sw) ClTraffic Mit Eval <br />'[]Site Work/Drainage ElAddress Letter <br />;C1Backfiow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />................................. <br />❑Route this folder for PW Review at end- - PW ReviewWorkshee#.-- <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit M PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope"— PW Not Required <br />Additional Notes: <br />0 <br />Completed y: kMdMkJW2&2Date: 1& b— <br />