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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT#v307-O(O5 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ElRoute to Residential Building A-2`C p b,A*V6v1 Residential Use <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size ' 1511,(-):f'4'V IN) Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size 4-pig.), (,OV►vol to blew" Planning/Landscape Inspection Required before Final? ❑Yes ❑No- <br /> Number of Stories i "In Lieu"Fee:Type: Amount$ <br /> Basement IgNo ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction t Calculated: Credit: <br /> Occupancy Group 7i1;74, El 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 Not Req'd Park Impact Fee Total$ <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System tINot Req'd Permit Technicians:Apply 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 (8 No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes 12No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ )D0,erd Additional Notes: <br /> rz//3 oa <br /> Approved By: AS. Date.'`) /1/ 2— <br /> PUBLIC WORKS <br /> Additional Notes: Apr 0-,,ted Arstik 1, Intake OK by: Date: <br /> Agir&PIY. 11) relrwi• 1j105R-R•tAtiitn.', ® NW PWw Worksheet <br /> Intake Comments: ;_ , ,_ .., . <br /> Needed if <br /> IDSys Dev Eval OTraffic Mit Eval <br /> Approved By: Date: t 7,1 0 6l7) I['Site Work or Drainage Proposed <br /> irl <br /> ❑Backflow Prevention for high hazard: <br /> f(dentai,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 El 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 /> A 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 0 Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: K ,`) rAi r Date: 13-3_,2y ❑ Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: ;7 T t Date: n7.A1 23 <br />