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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 230 ` -Ob 2 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone mL) <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use Lli aI <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> i <br /> Bldg/TI/Addn/ em Si �,y 7 7 0"F Total No.of Dwelling Units: <br /> Garage/Accessory Struct. Size A✓/A Planning/Landscape Inspection Required before Final? VP< ❑No <br /> Number of Stories / "In Lieu" Fee:Type: Amount$ <br /> Basement No DYes , Fin/Unfin School Impact Fee: Total $ / <br /> Type of Construction 1/LI Calculated: Credit: <br /> Occupancy Group g ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 2-if Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: Jpdate Existing CI New System El Not Req'd Park Impact Fee Total$ V. (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: 1pdate Existing El New System El Not 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? DYes 1St No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? <br /> Cs DYes -No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ / 70 coo cd-' Additional Note <br /> PP <br /> � q/77t <br /> ç1 / e <br /> d BY: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: a�osiiii: 1 <br /> Intake Comments: 1PW Worksheet Needed if: <br /> 1'D ieNt1� i❑Sys Dev Eval(util/sW)❑Traffic Mit Eval <br /> Approved Dater�//T-O7� `lb�Ott1 IDSite Work/Drainage ❑Address Letter <br /> ❑Backflow Prevention for high hazard: <br /> _(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT ;supportive housing) <br /> Separate/Deferred Submittals Required: El Route this folder for PW Review at end ---PW Review Worksheet <br /> Fire Sprinklers Aire 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 /> aReview/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:�[ , ( Date: 3 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> \� � 10 <br /> ,23 ri Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes' <br /> Additional Notes: 1 4 "4(J1j. Aikt . <br /> Approved By: Date: Completed r; 1\g/him., Date: ,rj <br />