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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# cP...304f ^ Q 5" <br /> BUILDING • OWNING <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 /> BIdg/TWAddn/Rem Size a- to 4+1 Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size — Planning/Landscape Inspection Required before Final? CIYes ONo <br /> Number of Stories 1 "in Lieu"Fee:Type: Amount$ <br /> Basement INo QYes, Fin/Unfin School impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group M ❑Everett School Dist DMukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 111/2022: <br /> Fire Sprinklers: IZUpdate Existing ONew System ONot Req'd Park Impact Fee Total$ (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: Update Existing ONew System ONot Req'd Permit Technician Use Only:Apply Phase-In 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 vworksheet req'd for permit? ❑Yes NI No ❑ 50%Credit-Issued d/3/2022-6/2/2023 <br /> Add'l RCW 64.55 does required prior to final? LIYes I lNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ moo,ooa Ad 'tiona[Notes: <br /> kapiL <br /> 14 I I,c(tZ% <br /> Approved By: Date: <br /> PUBLIC WORKS . . . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if- <br /> [(Sys Dev Eval(UtilfsW)❑Traffic Mit Eval <br /> Approved By: Date: 411 '.� EISite Work/Drainage ElAddress Letter <br /> 1 ❑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 Efire Alarm Other: EIThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND EICreate Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> 0 This Permit is Approved by Public Works <br /> Fire Dept.Fees: 0 See PW Review Worksheet and associated attached items <br /> Q Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#: PW ) <br /> ❑Minimal or No Fire Scope-NO FiRE FEE AND 0 Is located in this folder <br /> F'Review/Inspection Scope ADD FiRE FEE 0 is in a Separate Green Folder gob with this folder for permit issuance) <br /> Approved By: 91 .(\ Date: L. ..2, ' ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope--PW Not Required <br /> ELECTRICALIRLUiVIBING Additional Notes: <br /> Additional Notes: - U"U 14 I 2e)i' <br /> Approved By: Date: Completed : Date: <br />