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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 3 7,920 3 _6$1 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone nu <br /> Overlay/Agreement ii - �� \ <br /> El Route to Commercial Building Nonresidential Use 4 w-21 3(-41,NIV) <br /> El Route to Residential Building Residential Use ) <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size Total No. of Dwelling Units: <br /> Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? DYes EINo <br /> Number of Stories "In Lieu" Fee:Type: A nt$ <br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilte chool Dist 'v// <br /> Occupancy Load Park Impact Fees for permiapplied for after 1/1/2022: Ki/ <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(Year): <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In 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? DYes ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? DYes DNo ❑ 0%Credit-Issued 6/3/2023 or later O� <br /> VALUATION CALCULATION: Total$700 000, 0e" Additional Notes: 'S�f1.. cl 1 AZ Z -K3 <br /> Approved By: Date: 1.4.cv, 7. 3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: I PW Worksheet Needed if: <br /> Sys Dev Eval(Util/SW)❑Traffic Mit Eval <br /> Approved Date: v�l7/t oz 3 i❑Site Work/Drainage DAddress Letter <br /> ❑Backflow Prevention for high hazard: <br /> i(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 El 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: ❑ 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 aoin 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 /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: <br />