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intake &Approval Sheet OFOR PERMIT STAFF ONLY) PERMIT# :;$23000 <br /> BUILDING tANNING <br /> Intake OK by: Date: Intake OK by:i Assign To: 3 es S Date:(o/Z JZ3 <br /> Intake Comments: Intake Commen" ts: <br /> Zone M V <br /> Overlay/Agreement Connethoc Si-ree*- <br /> ❑ Route to Commercial Building Nonresidential Use Gl iYl ic. <br /> ❑ Route to Residential Building Residential Use IS IA <br /> ❑ Make this a"W"Permit Proposed No. of Dwelling Units: N(pt <br /> Bldg/TI/Addn/Rem Size '/t<6' "sir Total No. of Dwelling Units: NjA <br /> Garage/Accessory Struct. Size A/0 Planning/Landscape Inspection Required before Final? ❑Yes l'No <br /> Number of Stories "In Lieu" Fee:Type: Amount$O <br /> Basement rgrNo Oyes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction L.44 Calculated: Credit: <br /> Occupancy Group 8 ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load ZZ Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers:p,Update Existing ❑New System ❑Not 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: AnUpdate Existing El New System ❑Not 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 I No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes gNo 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$240 OW.00 Additional Notes: <br /> Approved By:gCddua Date:(o/Z fZ3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ��g A. <br /> ❑Sys Dev Eval(Util/SW) ❑Traffic Mit Eval <br /> Approved • Date:G, P <br /> ���"tSE ❑Site Work/Drainage ❑Address Letter <br /> / Oa 0•Ai1 ('A{C..4❑Backflow Prevention for high hazard: <br /> * r% w•t►iC*_(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT C, -T-µ,I,04 -Cri -r w- supportive housing) <br /> Separate I 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: ❑ 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 /> gl Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:,�/ d� n Date: � 3 �� ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> fgpublic Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By�77� � Date: 061• /1e1:3 <br />