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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 57i3®3 o4g <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: -IA^A Date: `i IS 123 <br /> Intake Comments: Intake Comments: <br /> Zone Q.-5 <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use I S <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: t.p <br /> Bldg/TI/Addn/Rem Size 1/6, SF Total No. of Dwelling Units: 1 <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes 'No <br /> Number of Stories l "In Lieu" Fee:Type: __ Amount$ <br /> Basement ❑No EYeS ,(%Unfin School Impact Fee: Total $ / <br /> Type of Construction { Calculated: Credit: <br /> Occupancy Group .�} El Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: <br /> �+ �a (+ tgtz) <br /> Fire Sprinklers: ❑Update Existing ❑New System L�Ji�ot Req'd Park Impact Fee Total$ l o <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 2AZ-3 <br /> Fire Alarm: CI Update Existing ❑New System TNot Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ILL 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1���ppNo O 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 does required prior to final? ❑Yes Mk) 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total $ IS( 1 C' Additional Notes: I4{C-rn4l wv!' o1lr nu aciu"c^Al /+v+3 V,' <br /> vl,, rev;fed F,.„141 :;hd+hbil.S,�IIHHn4 4 � <br /> SCAen,��c. ( 3 <br /> Approved By: -leckck' NA"1-�I/ Date: /l 1 S'L7 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> � [, / i <br /> Approved By: :�P.n Date: g/rt+j , 27> I❑Site Work or Drainage Proposed <br /> ( t I.❑Backflow Prevention for high hazard: <br /> I(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 El Fire Alarm El Other: El 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: El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 4:J Public Works has no scope PW Not Required <br /> ELECTRICAL/PLUMBING Additional.Notes: ' /' <br /> Additional Notes: /pp I nkt SiFL /,mak r€ u�•r@S CL __"- G?W�j L/C. 11(44b <br /> Approved By: _ Date: ' _ _` Approved By: Date: 'jjd pZ t� <br />