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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �-30 6--v0,6 <br /> BUILDING • . • PLANNING &fir^,a21„240 <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: DUpdate 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 Calculation(Year): <br /> Fire Alarm: ❑Update Existing Mew System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMCI9.53.200 <br /> Reason Fire Alarm Required: El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? DYes ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I ROW 64.55 docs 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 it <br /> DSys Dev Eval(Util/sW)OTraffic Mit Eval <br /> Approved By: Date: DSite Work/Drainage 17Address Letter <br /> DBackflow 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 ❑Create 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 /> Eft-Review/inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:\69,en r.�n Date: 6 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/RLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />