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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDINGANNING <br /> Intake OK by: "P Date: Jo I *f zZ- Intake OK by. Assign To: Date:q720l22 <br /> Intake Comments: Intake Comments: <br /> Zone `J21 <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> Route to Residential Building Residential Use <br /> ❑ Make this a"W". it Proposed No. of Dwelling Units: <br /> Bldg/TI/Addn Rem Size JSZS SE Total No. of Dwelling Units: <br /> Garage/Acces ruct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories I "In Lieu" Fee:Type: Amount$ <br /> Basement glNo ❑Yes, Fin/Unfin s School Impact Fee: Total $ <br /> Type of Construction - -- Calculated: Credit: <br /> Occupancy Group SQ-L El Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load ��— Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System ENot 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 'grNo ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yeslo 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 54310bO Additional Notes: <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: 01 J241_1(2D22--- <br /> Intake Comme <br /> (� "[�� ',A� PW Worksheet Needed if: <br /> "r�'f 1 M I ' ' I Sys Dev Eval OTraffic Mit Eval <br /> Approved By: i'��' 4 Date: ill I7-17.-7_ S I�Site Work or Drainage Proposed <br /> 1111 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate/Deferred Submittals Required: DRoute 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 /> Ig This Permit is Approved by Public Works <br /> Fire Dept. Fees: Eg See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE VA Separate PW Permit is Required (Permit#: PW 2201-620 ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND r5L1 Is located in this folder S <br /> 0 Review/Inspection Scope-ADD FIRE FEE 0 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 /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: sItAal,ft dAVATOVJDate: Oq f ..01)Po0 0 <br />