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Intake & Approval Sheet OfOR PERMIT STAFF ONLY) - PERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />[]No []Yes, Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing []New System []Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $ ,joy a!7 <br />Additional Notes: <br />Approved B Datef% % 7/J Z6z3 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />Review / Inspection Scope - ADD FIRE FEE <br />Approved By: rj(c) n Date: % Vo �3 <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? ❑Yes []No <br />- <br />"in Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ <br />Fee Schedule Used For Calculation (Year): <br />Permit Technicians: Apply Credit Per EMC19.53.200 <br />❑ 100% Credit- Issued 1/1/2022 - 9/2/2022 <br />❑ 50% Credit - Issued 9/3/2022 - 6/2/2023 <br />❑ 0% Credit - Issued 6/3/2023 or later <br />Additional Notes: <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: 3PIN WorksheetNeeded if. <br />[]Sys Dev Eval I]Trafric Mit Eval <br />0Site Work or Drainage Proposed <br />=OBackflow Prevention for high hazard: <br />=(dental, medical, animals, mortuary, hospital, <br />( <br />:supportive housing) <br />......................... ........ ...._...,.,_.... . ... ..... ........... _... ..... <br />._- .........,.,,.,,...,m,_..._. <br />❑ Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑,A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folderfor permit Issuance) <br />❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: Date: <br />