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Intake &Approval Sheet FOR PERMIT STAFF ONLY) PERMIT# g a a D 9-0,,-3 <br /> BUILDING PLANNING <br /> Intake OK by: Q- 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 o <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No ❑Yes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction G Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load p2C_ Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System Ig&ot 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: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes "-No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ErNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total $ IS/OO b Additional Notes: <br /> F.___A.Agqproved B Date: q,-2, ,Z Z <br /> UBLIC WORKS <br /> Additional Notes: Intake OK by: Date: a 124 1 Ina, <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Approved By: 'E-k Date: e/ 1 f'Z,r"Z OSite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTME supportive housing) <br /> Separate/Deferred Submittals:-quired: ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> El Fire Sprinklers ❑Fire arm ❑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. F,-s: ❑ See PW Review Worksheet and associated attached items <br /> ❑ Revi- of As-Built Plans-NO FIRE FEE ❑ A Separate PW Permit is Required (Permit#: PW <br /> ❑ nimal or No Fire Scope-NO FIRE FEE AND ❑ 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 <br /> l Note <br /> w Additional Notes: I C `GNI Qr1441t. <br /> Approved By: Date: Approved B : , Date: 'L(V1241,1 <br />