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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING • 'PLANNING <br /> Intake OK by: Ckc Date: V1/4- Intake OK by: Assign To:Jess Date: 1 /O$/ZZ <br /> Intake Comments: Intake Comm s: <br /> Zone <br /> Overlay/Agreement Prsoe'vor`d <br /> ❑l Route to Commercial Building Nonresidential Use N/A <br /> A-Route to Residential Building Residential Use SF(L <br /> ❑ Make this a"W" Permit V Proposed No. of Dwelling Units: N/A <br /> Bldg/TI/�0odritRem Size (6.5 A� lo53 Total No. of Dwelling Units: <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes ,IgNo <br /> Number of Stories "In Lieu" Fee:Type: Amount$ <br /> Basement No ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group T t'-- ❑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 IQ Not Req'd Park Impact Fee Total$ (net due after credit for existing uses) <br /> Reason Sprinklers Required: rr Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System SNot 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? ❑Yes 1® No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes II No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total $_5O1 00 C) Additional Notes: <br /> Approved By: — Date: It /0 5/22 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: s-1 Date: ii IiJ2.2- <br /> Intake Comments: PW Worksheet Needed if: <br /> -..3-7ce „lkos.o e-s. <br /> n r� j II Z`� Lb (to 5- izoo F <br /> (. Sys Dev Eval(Util/SW) ❑Traffic Mit Eval <br /> Approved By: + 0 t Date: L1i6/ Za Lit P .�Ad, [,. ❑Site Work/Drainage DAddress 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 /> PI 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 22Al'b7 <br /> 0 Minimal or No Fire Scope-NO FIRE FEE AND L7i Is 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: Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: I`L00(tZQ27/ <br /> L/� <br />