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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2 3'o S 3pqg <br /> BUILDING • j •ANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Jess Date: 5/12/23 <br /> Intake Comments: Intake CommdrSYs: <br /> Zone M U <br /> Overlay/Agreement A IA+ACA,MFtEArea, <br /> ❑ Route to Commercial Building Nonresidential Use ReAicS‘ocus cac<<<4 <br /> ❑ Route to Residential Building Residential Use N/A <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: N/A <br /> Bldg/TI/Addn/Rem Size Co a-CP Total No.of Dwelling Units: N/A <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? DYes ONo <br /> Number of Stories 2_ "In Lieu"Fee:Type: Amount$C) <br /> Basement iflNo ❑Yes, Fin/Unfin School Impact Fee: Total $ 0 <br /> Type of Construction e= Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 1 3l Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: VlUpdate Existing❑New System ❑Not'Req'd Park Impact Fee Total$ O (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: klUpdate Existing ONew System ONot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ❑ 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'!RCW 64.55 docs required prior to final? ❑Yes }No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ fin, c)1712 Additional Notes: <br /> Approved By/e41.6 Date:5/12/23 <br /> PUBLIC WORKS - - - <br /> • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if• <br /> ❑Sys Dev Eval(util/sin) ❑Traffic Mit Eval <br /> Approved By: Date: (p'1) oZ . Mite Work/Drainage DAddress Letter <br /> ❑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 1AFire Alarm DOther: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> 0 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 /> El Review/Inspection Scope ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: 19-)co CA.) Date:5. ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> rigLE'ublic Works has no scope---PW Not Required <br /> ELECTRICAL(RLUM.BING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By."� Date: U.5/2 /Zd 2.3 <br />