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1 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) RM# jZ 1(�s—Oil <br /> BUILDING PLANNING <br /> Intake OK by: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone _ <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> Bld /TI/Addn/Rem Size Total No. of Dwelling Units: <br /> Garage/ ccessory Struct. Size �{� SE Planning/Landscape Inspection Required before Final? DYes FNo <br /> Number of Stories "In Lieu" Fee:Type: Amount$ <br /> Basement MNon '❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction T1`—`— Calculated: Credit. <br /> Occupancy Group =0-c- ❑Everett School Dist ❑Mukilteo School Dis <br /> Occupancy Load fX-- Park Impact Fees for permits applied for afte' 1/1/2022: <br /> Fire Sprinklers ❑Update Existing ❑New System lgfJot Req'd Park Impact Fee Total$ <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year) <br /> Fire Alarm: ['Update Existing ❑ LNew System LJNot Req'd Permit Technicians:Apply Credit Per EM 9.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/'022 <br /> RCW 64 55 MF worksheet req'd for permit? ❑ rs�Yes I No 0 50%Credit-Issued 9/3/2022-6/i/2023 <br /> f <br /> Add'I RCW 64 55 docs required prior to final? ❑Yes lErNo ❑ 0%Credit-Issued 6/3/2023 o later <br /> ,VALUATION CALCULATION: Total$ 32,6 q C) 1,Additional Notes: ►,1 -., 0---)) n6\eel O\_ eAffr> <br /> 614 O @ T Approved By: y_ 1 Date: q, Zz,2 7_ <br /> t\)() "270 . ,S4f UBLIC WORKS <br /> Additional Notes:,51 OT�� Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ASS OE-b <br /> / ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Approved By: �}-� Date: 9 f'2- 7:2_ ❑Site Work or Drainage Proposed <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 DOther: ['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: 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 ❑ Is located in this folder <br /> ❑ 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: Approved By: Date: <br />