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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# g1 L -4 (leDC.(-? <br /> BUILDING • LANNING <br /> Intake OK by: IZ,e4 Date: '` /' (2JZ Z_ Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: ig,lv,,�Lp' r r,_ <br /> Zone <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> El-Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes I♦ O. <br /> Number of Stories Z "In Lieu" Fee:Type: Amount$ <br /> Basement ErNo ❑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 :12--C- Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fee Total ', net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation ear): <br /> Fire Alarm: El Update Existing ❑New System ❑Not Req'd Permit Technician Use Only:A.•ly Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1 022-9/2/2022 <br /> '\\ \ f\r <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 50%Credit-Issued • 3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No 0 0%Credit-Issued./3/2023 or later ,o <br /> VALUATION CALCULATION: Total$ Z. 400 Additional Nottess:,q{W '�" /64,,frilw•-s `d <br /> (07tr <br /> Approved By: \4:x Date: 4I ZZ <br /> BLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> I;a A-110 L\VT' o I�L.y Intake Comments: PW Worksheet Needed if: <br /> C'ECIJL \i5PG 7 i\)5 k(2-E 620 teLq3 ❑SysDevEval(Util/SW)❑TrafficMitEval <br /> Approved By: g-P.f., Date: ltf.1(2oZZ. ❑SiteWork/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 /> ❑Fire 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: 0 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: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope---PW Not Required <br /> 1 ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br /> Z/Z <br />