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Intake &Approval Sheet Aii(FOR PERMIT STAFF ONL19 PERMIT#lbZ J(0 -c6,0 <br /> BUILDING IP ANNING <br /> Intake OK by: Date: Intake OK by: 1 Assign To: J e 55 Date:7/13/Z S <br /> Intake Comments: Intake Comme ts: <br /> Zone M l) <br /> Overlay/Agreement 1-,t e-vCcol pea• srkcee.'s- <br /> ❑ Route to Commercial Building Nonresidential Use en'reck'a"^"^e'^h•/e c j� r'' <br /> ❑ Route to Residential Building Residential Use N/A <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: N/A <br /> Bldg/TI/Addn/Rem Size Total No. of Dwelling Units: N/A <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes n No <br /> Number of Stories "In Lieu"Fee:Type: Amount$0 <br /> Basement ❑No ❑Yes , Fin/Unfin School Impact Fee: Total $ 0 <br /> Type of Construction y—;(' Calculated: Credit: <br /> Occupancy Group ,g ❑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 1Not Req'd Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ONew System,ot 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? ❑Yes RNo 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 $ !'000.00 Additional Notes: <br /> Approved By: Date: -7,43/Z3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: (i IVI 202d <br /> Intake Comments: PW Worksheet Needed if: <br /> � <br /> h,o-frA.f'f ibmi H (ii. ❑Sys Dev Eval(Util/SW)DTraffic Mit Eval <br /> Approved AD Date:0.,g/d7trf W 140Vt V►.A 'Ni1(� ❑Site 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: ❑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 ❑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 /> lEt Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: \, ,fir,J r? Date: 7_i3,.23 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> tgl Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By jitJi1/y14dWJ Date: flL 2O 7,b2b <br />