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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# c 3 06 ' ©S'? <br /> BUILDING , ,NNING <br /> Intake OK by: Date: Intake OK by:if Assign To: d e SS Date: (p/2 8/2j <br /> Intake Comments: Intake Commetsti <br /> Zone M <br /> Overlay/Agreement Cac+ne.c-4oc- sir--ee'Nr <br /> ❑ Route to Commercial Building Nonresidential Use Reko\ saes} sec-v 02.s <br /> ❑ Route to Residential Building Residential Use N/A <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: N/Ps <br /> BIdg/TI/Addn/Rem Size _ Total No.of Dwelling Units: NSA <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ®No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ C� <br /> Basement El No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑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 ❑Nofi 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 ❑New System Mot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes ❑No El 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$6t 0Oa.Ov Additional Notes: <br /> Approved By: Date:(p/i (23 <br /> PUBLIC WORKS <br /> Additional Notes: . Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed It <br /> ❑Sys Dev Eval(Util/sw)['Traffic Mit Eval <br /> Approved Date: 00 fiez ❑Site Work/Drainage ['Address Letter <br /> . ❑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 /> ` ire 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 /> ❑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 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 /> IA-Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: ,,hCbCA l() Date:,2 123 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> J Public Works has no scope---PW Not Required <br /> ELECTRICAL/RLUM.BING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By'j Date: (p[1(0 f uL3 <br />