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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0 f'—(�6/ <br /> S <br /> BUILDING . •LANNING <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 /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No ❑Yes , Fin/Unfin ' School Impact Fee: Total $ <br /> Type of Construction //-`/j Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 111/2022: <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 ❑Not Req'd Permit Technicians:Apply 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 ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ ObOrO/) Additional Notes: <br /> Approved By: 4 Date: 10111/ O2_Z... <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by- _ .I Date: L O1?J'[710 2 Z-' <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ApprovedBitt -474.4:7Date:/6Zj/ 7', ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> .,,, FIRE DEPARTMENT supportive housing) <br /> Separate/D erred 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 /> 0 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 FIR EE ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE F AND ❑ Is located in this folder • <br /> ❑ Review/In ection Scope-ADD FIRE FE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date:/0,00 zZ 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope---PW Not RequiredriG <br /> ELECTRICAL/PLUMBING dditional Notes: <br /> Additional Notes: NO Frr,-,' �^ 77 <br /> W vC4 ptj to iI ze *? <br /> Approved By: Date: Approved By: Date: <br /> ..2-b_ <br />