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Intake &Approval Sheet *OR PERMIT STAFF ONLY) Ai PERMIT# <br /> BUILDING •NNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone li6 <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use Sa.AY <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement I71No ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction YID Calculated: Credit: <br /> Occupancy Group /ri ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for pern7applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System ErNot Req'd Park Impact Fee Total$ <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System ErNot Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> II Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 12t No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes E1 No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Additional Notes: Z! <br /> 13)03.6 7 ) <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: `PW Worksheet Needed if: <br /> ID Sys Dev Eval OTraffic Mit Eval <br /> Approved By: )/.I.,e4 att Date: CP//7/A is DSite Work or Drainage Proposed <br /> 10Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT 'supportive housing) <br /> Separate I Deferred Submittals Required: DRoute 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: 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 0 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:1K V:2 �),(‘ Date: 7 ;23 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 2f Jam' Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: ,,j fit' I \eve0 Date: 01 I plrj I Z Z <br />►i <br />