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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# eP-39 6 -0 i g <br /> BUILDING4110 ANNING <br /> intake OK by; Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone eb <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use (jU)yajarx-(-- <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a" " rmit Proposed No.of Dwelling Units: <br /> BIdg/Ti/Addn/ Si . Total No.of Dwelling Units: <br /> Garage/Accessory Strut.Size Planning/Landscape Inspection Required before Final? DYes ONo <br /> Number of Stories / "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction KG Calculated: Credit: <br /> Occupancy Group A Z.— ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/'I/2022: <br /> Fire Sprinklers: DUpdate Existing ❑New System t 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 ❑New System Not 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? DYes IF No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? DYes .1No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 750c 0,ob itional Note <br /> p<140P (p iq I2) <br /> pproved By; Date: <br /> PUBLIC WORKS . . .. <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/sW)(Traffic Mit Eval <br /> Approved B} .,`� Date 0 /2 7746tZr ❑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 AIarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate 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 /> FAI Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(loin with this folderfor permit issuance) <br /> Approved By: \, ,,,n Date: 6— 7 a23 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> WI-Public Works has no scope---PW Not Required <br /> ELECTRICAL/I?LUM.BING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By Date: p`is 1'L4)z3 <br />