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Intake &Approvai Sheet (FOR PERMIT STAFF ONLY) PERMIT# 304 ` 05ci <br /> BUILDING ANNING <br /> intake OK by: Date: Intake OK by: Assign To:—IAA Date: 'i/Z41sZ3 <br /> Intake Comments: Intake Comments: <br /> Zone f ) <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use BLS <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg1TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes 12tNo <br /> Number of Stories 2 "In Lieu" Fee:Type: Amount$ <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ O <br /> Type of Construction (.1L Calculated: Credit: <br /> Occupancy Group ig4-Z ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: ❑Update ExistingNew System ❑Not.Req'd Park Impact Fee Total$ /6 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update ExistinNew System ❑Not 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 M No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'RCW 64.55 docs required prior to final? ❑Yes qNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 4'&� 41 3 Additional Notes: <br /> Su, QA/v14,11 (-ww) afc,,;Vecif <br /> catn aka AO) r u s ed iro $I y(o,8 I i Approved By: � Date: `124/23 <br /> PUBLIC WORKS <br /> Additional Notes: intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Utii/SW) CiTraffic Mit Eval <br /> Approved ✓r Date:pr//j7/te, I: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 /> • ❑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 /> 2 Review/inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Approved By: s6.(--c2cAA--, Date: L/:j 3 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope--PW Not Required <br /> ELECTRICAL./PLUIVIBiNG Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />