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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ea, t 30 .(.:p 30 <br /> BUILDING IP •TANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone MO <br /> Overlay/Agreement <br /> El Route to Commercial Building Nonresidential Use <br /> ❑Route to Residential Building Residential Use ray 1-1-1-Pam It,y. <br /> El Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/Tl/Addn/Rem Size "' Le21:)--i"-1y Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size — PIanning/Landscape Inspection Required before Final? DYes ONo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement 0 No OYes, Fin/Unfin _ School Impact Fee: Total $ <br /> Type of Construction V a. Calculated: Credit: <br /> Occupancy Group fib.-2.. ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers:PilUpdate Existing ONew System QNot 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: glUpdate Existing ONew System OINot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC49.53.200 <br /> Reason Fire Alarm Required: ri El100°%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF Worksheet req'd for permit? ❑Yes WI No ❑ 50%Credit-Issued 0/3/2022-6/2/2023 <br /> Add'I ROW 64.55 does required prior to final? ❑Yes lkiNo El 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ goao Additional Notes: <br /> YloL,i- l/kr,t0 qil/23 <br /> Approved By: Date: 1 <br /> PUBLIC WORKS . 1 <br /> Additional Notes: icveaa.,-volt Remit, o,ri. Intake OK by: Date: <br /> ., . vamaccv_ . 13u t.4=A EN) rct r Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(util/sw) OTraffic Mit Eval <br /> Approved By: Date: 4/ 0120 '3- OSite Work/Drainage ❑Address Letter <br /> ❑Backflow 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 DOther: DThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate Green Folder CISubmitted Previously ❑Deferred <br /> 0 This Permit is Approved by Public Works <br /> Fire Dept.Fees: CI 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 /> Rt Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> Q Review/inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: te)co(.c.)r Date:''26 e23 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 4 Public Works has no scope--PW Not Required <br /> E .. CT.RICAL{RLUMBING Additional Notes: <br /> Additional Notes:Approved By: Date: Completed Byt——K. Date: 4 f 10 i <br /> w 23 <br />