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Intake & Approval Sheet (FOR PERMIT STAFF ONLI)
<br />�'GI'IS`ton u-�ie� 'Issue
<br />PERMIT # 6ZZ®0pO— 0 PI 0
<br />BUILDING
<br />Intake OK by: Date:
<br />Intake Comments:
<br />❑ Route to Commercial Building
<br />❑ Route to Residential Building
<br />❑ Make this a "W" Permit
<br />Bldg/TI/Addn/Rem Size
<br />Garage/Accessory Struct. Size
<br />Number of Stories
<br />Basement
<br />[]No ❑Yes , Fin / Unfin
<br />Type of Construction
<br />Occupancy Group
<br />Occupancy Load
<br />Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd
<br />Reason Sprinklers Required:
<br />Fire Alarm: El Update Existing []New System ❑Not Req'd
<br />Reason Fire Alarm Required:
<br />RCW 64.55 MF worksheet req'd for permit? []Yes ❑ No
<br />Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No
<br />VALUATION CALCULATION: Total $
<br />Additional Notes:
<br />Approved B ti Date:C r Z,7 L4TJ
<br />FIRE DEPARTMENT
<br />Separate / Deferred Submittals Required:
<br />El Fire Sprinklers ❑Fire Alarm ❑Other:
<br />Additional Notes:
<br />Fire Dept. Fees:
<br />❑ Review of As -Built Plans - NO FIRE FEE
<br />❑ Minimal or No Fire Scope - NO FIRE FEE
<br />❑ Review / Inspection Scope - ADD FIRE FEE
<br />Approved By: Date:
<br />ELECTRICAL/PLUMBING
<br />Additional Notes:
<br />Approved By: Date:
<br />PLANNING
<br />Intake OK by: Assign To: Date:
<br />Intake Comments:
<br />Zone
<br />Overlay/Agreement
<br />Nonresidential Use
<br />Residential Use
<br />Proposed No. of Dwelling Units:
<br />Total No. of Dwelling Units:
<br />Planning/Landscape Inspection Required before Final? []Yes []No
<br />"In Lieu" Fee: Type: Amount $
<br />School Impact Fee: Total $
<br />Calculated: Credit:
<br />[I Everett School Dist ❑Mukilteo School Dist
<br />Park Impact Fees for permits applied for after 1/112022:
<br />Park Impact Fee Total $ (net due after credit for existing uses)
<br />Fee Schedule Used For Calculation (Year):
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<br />Permit Technician Use Only: Apply Phase -In Credit Per EMC19.53.200
<br />❑ 100% Credit- Issued 1/1/2022 - 9/2/2022
<br />❑ 50% Credit - Issued 9/3/2022 - 6/2/2023
<br />❑ 0% Credit - Issued 6/3/2023 or later
<br />Additional Notes:
<br />Approved By: Date:
<br />PUBLIC WORKS
<br />Intake OK by: Date:
<br />,,,,,,,,,,,,,,,,,,,,,,,.,,.,.,,.,.......................... ............. ,,.,,,...,.,.,,..... ........... ,....,,,.......... .......... ,......,,,,,..............
<br />Intake Comments: €PIN Worksheet Needed if:
<br />❑Sys Dev Eval (utiiisw) ❑Traffic Mit Eval
<br />❑Site Work/Drainage ❑Address Letter
<br />❑Backflow Prevention for high hazard:
<br />:(dental, medical, animals, mortuary, hospital,
<br />_supportive housing)
<br />.............................................................................................................................................................
<br />❑ Route this folder for PW Review at end --- PW Review Worksheet
<br />❑This project also has a separate concurrent PW Review (Green Folder)
<br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred
<br />❑ This Permit is Approved by Public Works
<br />❑ See PW Review Worksheet and associated attached items
<br />❑ A Separate PW Permit is Required (Permit #: PW )
<br />AND ❑ Is located in this folder
<br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance)
<br />❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg)
<br />❑ Public Works has no scope --- PW Not Required
<br />Additional Notes:
<br />Completed By: Date:
<br />
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