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Intake &Approval Sheet ip(FOR PERMIT STAFF ONLY) di) PERMIT# 322 It-023 <br /> BUILDING 111PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone NT6 <br /> Overlay/Agreement❑ � �Route to Commercial Building Nonresidential Use ,QA{ - <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> Bldg/TI/Ad / eni Si SO D iF 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 g,No ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction VI,> Calculated: Credit: <br /> Occupancy Group 3 ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load % Park Impact Fees for permits applied for after 1/1/2022:k)'()'✓ <br /> Fire Sprinklers: ❑Update Existing ❑New System (allot 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 Systemot 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 ,.No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes PNo 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$Si 3 G f�, yI Additional Notes: ' I) <br /> Approved By ``7 3� I�\1n, �Q Date: ' 12� <br /> v" PUBLIC WORKS 6 <br /> Additional Notes: Intake OK by: ( Date:14 I� Z2 <br /> Intake Comments: PW Worksheet Needed if: <br /> �,� ❑Sys Dev Eval(util/SW)OTraffic Mit Eval <br /> Approved By j,��/G�7 Date:f37-- y/ZbZ 3 ❑Site Work/Drainage DAddress Letter <br /> OBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate/Deferred Submittals Required: DRoute 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 0 A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder <br /> AEI-Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:Y..,.9:){d(NY1 Date: ,_ )--23 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> VI Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: 4t Jt 4tfA/vvlQvtii___- al 1.2t, 2 <br /> Approved By: Date: Completely: Date: <br /> �/ <br />