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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# S A 3 0 1f —o 0 S <br /> BUILDING .ANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> O Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size 7 S/‘ Total No. of Dwelling Units: <br /> Garage/Accessory Struct.Size L/7% Planning/Landscape Inspection Required before Final? DYes ONo <br /> Number of Stories / "In Lieu" Fee:Type: Amount$ <br /> Basement EINo ❑Yes , Fin/Unfin School Impact Fee: Total $ #11- •V _ <br /> Type of Construction _7l Calculated: (fraiverr Credit: <br /> Occupancy Group .�,e_C verett School Dist DMukilteo School Dist <br /> Occupancy Load ( Park Impact Fees for permits a plied for after 11112022: <br /> Fire Sprinklers: DUpdate Existing ONew System fA Not*Req'd Park Impact Fee Total$ . (net due after credit for ' in uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): , C <br /> Fire Alarm: DUpdate Existing ❑New System ESI Not Req'd Permit Technician Use Only:Apply Phase-1n Credit Per EMC19.53.200 <br /> El Fire Alarm Required: 100%Credit-Issued 1/1/2022-9/2/2022 <br /> in <br /> n�0 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Ll No 0 50%Credit-Issued 9/3/2022-6/2/2023 Y \" UO <br /> k,,y <br /> (1_, <br /> Add!RCW 64.55 docs required prior to final. ❑Yes -�No <br /> 0 0%Credit-Issued 6/3/2023 or later V..0 <br /> VALUATION CALCULATION: Total$ 5`Fv k Additional Notes: <br /> /q, 7)c �47 . <br /> Approved By: , �— �1:zF---Date: -may-�� <br /> • y7/>c,76 ` <br /> PUBLIC WORKS . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/SW) OTraffic Mit Eval <br /> Approved By: Date:t2/7 A07� ❑Site Work/Drainage OAddress Letter <br /> OSackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> •FIRE DEPARTMENT supportive housing) <br /> Separate/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: 11 See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE RI A Separate PW Permit is Required(Permit#: PW23b4- On* ) <br /> ®•Minimal or No Fire Scope-NO FIRE FEE AND Els 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: (,1/II Date: 41-C„,23 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope--PW Not Required <br /> ELJCTRICALII?LUMBING Additional Notes: <br /> Additional Notes: _ <br /> Approved By: Date: Completed 13y:-7pw47 Date: 0 4--7/2o23 <br />