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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �3 0 ' o 3 q <br /> BUILDING SINNING <br /> Intake OK by: Date: Intake OK by:i Assign To:3ess Date: ,/2a`Z 3 <br /> Intake Comments: Intake Comments: <br /> Zone R_X <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use enceolrwctosP.d8.rect-ea3r;on, <br /> ❑ Route to Residential Building Residential Use N/A <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: N/A <br /> BldgiTIlAddn/Rem Size Total No.of Dwelling Units: N/A <br /> Garage/Accessory Struct.Size PIanning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories �, "In Lieu"Fee:Type: Amount$U <br /> Basement ❑No F4Yes, it ,Unfin School Impact Fee: Total $ 0 <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after'[/1/2022: <br /> Fire Sprinklers: DUpdate Existing ❑New System I Not Fteq'd Park Impact Fee Total$ I90, t 0 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year):'in 3 <br /> Fire Alarm: ❑Update Existing ❑New System 10Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMCI9.53.200 <br /> Reason Fire Alarm Required: El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes EI No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes Ilo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Additional Notes:New cornnnercic.,\ *pace,668,196€ <br /> Approved By..144 1 tn 4 � Date:WZct/23 <br /> PUBLIC WORKS • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> ❑Sys Day Eval(Util/SW)❑Traffic Mit Eval <br /> Approved By: L �Qvs Date: q' ,// 1? ❑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 /> `t -ire Sprinklers EFire 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 /> ❑yy Minimal or No Fire Scope-NO FIRE FEE AND El Is located in this folder <br /> a'Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Goln with this folder for permit issuance) <br /> Approved By: * cow() Date:6-/ ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> OPublic Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By."�vim, Date: O G. (tie I7.4 e <br />