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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) PERMIT# -Z I l ' G& <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:, Assign To: 3 e.5S Date: 11(ZZ/22 <br /> Intake Comments: Intake Commen <br /> Zone Utz 14 <br /> Overlay/Agreement AIA&ACA,Sidewalk r�rio�it.1 <br /> ❑ Route to Commercial Building Nonresidential Use N/A rr J <br /> ❑ Route to Residential Building Residential Use 4t,Ifi- farvtii 1 <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: NIA <br /> BldgITI/Addn/Rem Size 0 2- Total No. of Dwelling Units: WA <br /> Garage/Accessory Struct. Size — Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Number of Stories 3 "In Lieu"Fee:Type: Amount$ <br /> Basement D?INo ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction V-- I: Calculated: Credit: <br /> Occupancy Group W..-2— ❑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 tklNot Req'd Park Impact Fee Total$, (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? IIYes ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ �o�oa' Additional Notes: <br /> Approved By: Date: I►it LiZZ <br /> PUBLIC WORKS <br /> Additional Notes: c, \eS Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/SW)❑Traffic Mit Eval <br /> Approved By: E 7 Date: 21224 2-v2,3 ❑Site Work/Drainage DAddress Letter <br /> lr ❑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 El 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 /> O Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <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: <br /> Approved By: Date: Completed By: Date: <br />