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Intake &Approval Sheet FOR PERMIT STAFF ONLY) Aik PERMIT# .62 JO1^ 0 l <br /> BUILDING --7 -7 PLANNING <br /> Intake OK by: � Date: // 72.& 3 Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> Elf-Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: ♦0 <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? DYes 'No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No DYes , Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction / Calculated: Credit: <br /> Occupancy Group / )c- Cl Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 1 ��y- Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: DUpdate Existing ['New System L�JNot Req'd Park Impact Fee Total$ <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: DUpdate Existing ❑New System 'Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: rr�� 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? DYes El No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'i RCW 64.55 docs required prior to final? DYes ''No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ . Oi O Additional Notes: <br /> Approved By!1:1(1w//la Date: ,/.7i121)23 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> I❑Sys Dev Eval OTraflic Mit Eval <br /> Approved By: 44yy9,A___�y 18 Date:?4 ,,/2 2. Osite Work or Drainage Proposed <br /> DBackflow Prevention for high hazard: <br /> 1(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 DFire Alarm DOther: OThis project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By Date: �/r ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Ia`Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: ,� <br /> Approved By: Date: Approved By�/�? � 1/' Date: ei 1i 4itv t1 <br />