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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Z3 Z <br /> BUILDING IF "PLANNING <br /> Intake OK by: 9..1 4 Date: 11 WDZ 3 Intake OK by: Assign To:3 ess Date: 2/t JZ S <br /> Intake Comments: Intake Comm s: <br /> Zone _ R-S <br /> Overlay/Agreement Al A <br /> ❑ Route to Commercial Building Nonresidential Use _ N/A <br /> Er-Route to Residential Building Residential Use SF <br /> ❑ Make this a"W"Permit Proposed No. of Dwelling Units: Is/A <br /> Bidg/TI/Add em SJ 1 j 5 Total No.of Dwelling Units: J <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes INo <br /> Number of Stories 1 "In Lieu"Fee: Type: Amount$ <br /> Basement ❑No ®Yes 6i9Unfin School Impact Fee: Total $ <br /> Type of Construction (12-C.- Calculated: Credit: <br /> Occupancy Group 1O--C- ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load "i(1--(' Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ONew System ENot 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 El New System SNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: �I 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes to No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes INo 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ /O©O Additional Notes: <br /> Approved By: Date: 2/1 Z,3 <br /> • PUBLIC WORKS <br /> Additional Notes: Intake OK by:, 0 Date: o, ri 126Z' <br /> Intake Comments. PW Worksheet Needed if: <br /> ❑Sys Dev Eval(UtiltsW)❑Traffic Mit Eval <br /> Approved By: _ \{ Date: t 7j(-?_c323 <br /> OSite 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 /> ❑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 /> 0 Is in a Separate Green Folder Qoin 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 /> Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: (l 111 12 2. <br /> Approved By: Date: Completed Date: <br />