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Intake &Approval Sheet ` (FOR PERMIT STAFF ONLY) PERMIT# 6/ 7". — Oct 1 <br /> BUILDING 4PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: 32SS Date: I l IZ2/22 <br /> Intake Comments: Intake Comme . <br /> Zone U R <br /> Overlay/Agreement A I A+ACA,Sidewalk.Pci <br /> ❑ Route to Commercial Building Nonresidential Use N/A <br /> ❑ Route to Residential Building Residential Use M u I+;- m l <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: N/A <br /> Bldg/TI/Addn/Rem Size 2..1c' Total No. of Dwelling Units: p4/A <br /> Garage/Accessory Struct. Size — Planning/Landscape Inspection Required before Final? ❑Yes,EtNo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement talNo ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction R Calculated: Credit: <br /> Occupancy Group �- ,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 El 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 ONew System ZNot 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? IYes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IKINo 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 4o,cce Additional Notes: <br /> Approved By:/(, G Date:1 I Izz IZZ <br /> PUBLIC WORKS <br /> Additional Notes: icy PNA" Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/SW) ❑Traffic Mit Eval <br /> Approved By: 3' Date: 942212,02S DSite 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: DRoute this folder for PW Review at end ---PW Review Worksheet <br /> El Fire Sprinklers ❑Fire Alarm El Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> 0 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 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 />