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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# S 1-- 30 I " 0 0 , <br /> •BUILDING •LANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ri <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use ( g S -f/�jY] <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 $ Off <br /> Type of Construction _ Calculated: Credit: <br /> Occupancy Group DEverett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for per its 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: I: 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <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 $/1 ()CV,vd Additional Notes: <br /> Approved By: Date: <br /> • PUBLIC WORKS <br /> Additional Notes: Intake OK by:—�— Date: 01 103_24EIL� <br /> Intake Comments: PW Worksheet Neede <br /> d if: <br /> ❑Sys Dev Eval (Util/SW)❑Traffic Mit Eval <br /> Approved B t4774 Date:Pz�y rwr.3 ❑Site Work/Drainage DAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> ------------------------------------- <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 ODeferred <br /> ❑This Permit is Approved by Public Works <br /> Fire Dept. Fees: 0 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 /> ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> El Review/Inspection Scope-ADD FIRE FEE <br /> Approved By: Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> W"+ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: ©`'it•y023 <br /> Approved By: Date: Completed Date: <br /> liJ <br />