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Intake & Approval Sheet FOR PERMIT STAFF ONLY) PERMIT# Th02-6 <br /> BUILDING INNING ' <br /> 'Intake OK by: Date: Intake OK by: Assign To: Je SS Date: I I 23 <br /> Intake Comments: Intake Comme ts: <br /> Zone __a_— <br /> Overlay/Agreement Non.e. <br /> ❑ Route to Commercial Building Nonresidential Use _N/A <br /> ❑ Route to Residential Building Residential Use 5 F R s A UU <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: <br /> BldgfT1/Addn(em Si BOO S Total No.of Dwelling Units: 2 <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes ON° <br /> Number of Stories ' 1 "In Lieu"Fee: Type: Amount$ 0 <br /> Basement ❑No ®.Yes ,(Fin/ nfin School Impact Fee: Total $ 0 <br /> Type of Construction .. l2-� Calculated: Credit: <br /> Occupancy Group :�--V-s: ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load —212 Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing El New System FU lot Req'd Park Impact Fee Total$ 2/12 0 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 2.02 3 <br /> ot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Fire Alarm: ❑Update Existing ONew System <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 tf No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IgNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ SO/O4! Additional Notes: <br /> Approved By:v Date: 6/l z iZ 3 <br /> • PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval(Util/SW)[Traffic Mit Eval <br /> Approved By: gppi Date: G//D/2O2,? OSite 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: DRoute this folder for PW Review at end ---PW Review Worksheet <br /> El Fire Sprinklers OFire 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: E.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 ❑ Is located in this folder <br /> 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> El Review/Inspection Scope-ADD FIRE FEE <br /> Approved By: Date: 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: , D/te: 0 to' ob y23 <br />