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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# �-02® <br /> BUILDING •LANNING <br /> Intake OK by: Date: Intake OK by: e Assign To: J 2 ss Date: 1/13/Z3 , <br /> Intake Comments: Intake Comments: <br /> Zone M V <br /> Overlay/Agreement Nlesseo,ped.st }ree , <br /> p u.-1c,nc6 area A <br /> ern'rer}alrvrwerOr+-recre akto,n' <br /> ❑ Route to Commercial Building Nonresidential Use extcA ased. <br /> ❑ Route to Residential Building Residential Use Elul+i—family <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: ,. A <br /> Bldg/TI/Addn/Rem Size '7 V"13 Sr Total No.of Dwelling Units: rat, <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes IgNo <br /> Number of Stories t C, 1 "In Lieu"Fee:Type: Amount$(' <br /> Basement V No ❑Yes, Fin/Unfin School Impact Fee: Total $ 0 <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group A 3 ii ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 1/(91 1 Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: Update Existing El New System ❑Not Req'd Park Impact Fee Total$ 0 <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ®Update Existing El New System El Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 53 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$ 3 10 p 0 Additional Notes: <br /> Approved By: Date:7/i3/Z3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: IPW Worksheet Needed if: <br /> IDSys Dev Eval ❑Traffic Mit Evai <br /> Approved By: L � r.NU)\ Date: kki C Ali ; <br /> ❑Site Work or Drainage Proposed <br /> DBackflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT _supportive housing) <br /> Separate I Deferred Submittals Required: ['Route this folder for PW Review at end ---PW Review Worksheet <br /> Fire Sprinklers Fire Alarm ❑Other: OThis 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 /> Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit Issuance) <br /> Approved By:Kr 5,,/W`1 Date:7-10:23 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By:2r,[,��te---' Date: 7/0i/may <br />