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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# r r 1230F 0?i1 <br /> BUILDING • 0 •LANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ' <br /> Overlay/Agreement ,4-y O <br /> ❑ Route to Commercial Building Nonresidential Use Qh5-1-(tuyQ - <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 DEverett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for per 'ts 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 Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ ZL 500,00 Additional Notes:F(nor'Van i(l Gorn`Leo m 211 r7-00-7 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(UtiUSW)DTraffic Mit Eval <br /> Approved B . Date'j}yzyrot J ❑Site Work/Drainage DAddress 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 El 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 /> Cl 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 /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />