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Intake &Approval Sheet 4OR PERMIT STAFF ONLY) PERMIT# S — 02s <br /> BUILDING i'NING <br /> Intake OK by: Date: intake OK by:# Assign To:J 2ss Date: (oh 8/Z3 <br /> Intake Comments: Intake Comments: <br /> Zone M <br /> Overlay/Agreement ?ea+coArlecirot-5+r-ee.'f <br /> ❑ Route to Commercial Building Nonresidential Use G\irtG <br /> ❑ Route to Residential Building Residential Use N/A <br /> ❑ Make this a"VV" Permit Proposed No.of Dwelling Units: /p, <br /> Bidglll/AddnlRem Size Total No.of Dwelling Units: N//A <br /> Garage/Accessory Struct.Size Planning/Landscape inspection Required before Final? ❑Yes �No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ O <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ 0 <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 1/1/2022: <br /> Fire Sprinklers: Update Existing ❑New System ❑Not'Req'd Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Reason Sprinkles Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: pdate 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? Dyes ❑ No ❑ 50%Credit-Issued 0/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No ❑ 0%Credit Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ yv 000,pe31 Additional Notes: <br /> Approved By: Date:(o/28/Z3 <br /> PUBLIC WORKS • • • <br /> Additional Notes: , Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed If: <br /> ❑Sys Dev Eval(Utii/SW) (Traffic Mit Eval <br /> Approved B 4 Date:fJ//X�OZlf Mite Work/Drainage DAddress 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 ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> • <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 0 Is located in this folder <br /> .Review/inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder5otnwiththisfolderforpermitIssuance) <br /> Approved 13y:K (a�Y� Date:6,_.„.21_3,23 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Ilii(Public Works has no scope—PW Not Required <br /> ELECTRICAL/RLUMBING Additional Notes: <br /> Additional Notes: 0 Lt,• Gs ALP-SM.-a'? i-L4S ( 4u AGit_rGOw <br /> Approved By: Date: Completed By: Date: (p f6/zov3 <br />