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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# S7 3o3"0101 <br /> BUILDING PLANNING <br /> d-- <br /> / <br /> Intake OK by: Date: Intake OK by: Assign To: 3.S S Date: 4 /y/Z`3 <br /> Intake Comments: Intake Comments: <br /> Zone LT Z <br /> Overlay/Agreement Al A,AG A,SeSVO,S b rzxeI-I <br /> ❑ Route to Commercial Building Nonresidential Use equip nse1^Y' Se►.tes <br /> ... h d reanra‘ ,_ <br /> ❑ Route to Residential Building Residential Use u/A <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: Ni A <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: OA <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes.. o <br /> Number of Stories "In Lieu"Fee:Type: Amount$ 0 <br /> Basement ❑No ❑Yes , Fin/Unfin School Impact Fee: Total $ 0 <br /> Type of Construction Calculated: 0 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 /> Fire Sprinklers: ❑Update Existing ❑New System [Lot Req'd Park Impact Fee Total$ 0 <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <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 0 No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0 No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total $� J'SS.Oo Additional Notes:ProposoA ex-vends beyond propertu, <br /> / boundaa;.c,s, 043acerir owners' perrn'uss%en required• <br /> Approved By: Date:gill/• ,' <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> /��, Intake Comments: I PW Worksheet Needed if: <br /> v ` G/ ,%c't3 I_ <br /> Sys Dev Eval ❑Traffic Mit Eval <br /> Approved Date: c'.t6/'r' 7)3 ICISite Work or Drainage Proposed <br /> 1❑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 DOther: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> IA 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 ❑ A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> ill Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:\<i V r of A.in Date:�-/�� El� Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ����``� 9-- 2:2 5 ❑ Public Works has no scope---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: A'ytivtA 'Date: 04 091�o�3 <br /> W*VA`Cloys aa, w cl 1 1 J2023 <br />