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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# 504- — 0�'
<br /> BUILDING PLANNING
<br /> Intake OK by: Date: Intake OK by: Assign To: Date:
<br /> Intake Comments: Intake Comments:
<br /> Zone UJfL—
<br /> Overlay/Agreement
<br /> ❑ Route to Commercial Building Nonresidential Use
<br /> El /Route to Residential Building Residential Use t3j'"-Tz—
<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 b/ 9(9 fP' Planning/Landscape Inspection Required before Final? ❑Yes El No
<br /> Number of Stories l "In Lieu" Fee:Type: Amount$
<br /> Basement EINo ❑Yes , Fin/Unfin School Impact Fee: Total $
<br /> Type of Construction ; P+�.0 Calculated: Credit:
<br /> Occupancy Group .2&k_ ❑Everett School Dist ❑Mukilteo School Dist
<br /> Occupancy Load LR-L- Park Impact Fees for permits applied for after 1/1/2022:
<br /> Fire Sprinklers: ❑Update Existing ❑New System EtNot Req'd Park Impact Fee Total$ (net due after credit for existing uses)
<br /> Reason Sprinklers Required: Calculation(Year):
<br /> Fee Schedule Used For Ca...............................,.,,,,..,.,...,,.....,,,..,,,,,..,,,,,.,,,,.,,,,..,,,,.,,,,,,,,,,,,..,,,.,,.,,,,.,,,.,.,,..................,........,,,...,...,,,,,,...,,..,...,,.,...,,,...,,,,.,,...,,,,.,,,.,,,,,,,
<br /> Fire Alarm: El 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 El No ❑ 50%Credit-Issued 9/3/2022-6/2/2023
<br /> Add'I RCW 64.55 dots required prior to final? ❑Yes .No 0 0%Credit-Issued 6/3/2023 or later
<br /> VALUATION CALCULATION: Total $ c tk/ ?. Flo Additional Notes:1OLt 1 YG+J -2- - OI" -L - no-s;�c 16-it-v cr
<br /> Approved By: Date:
<br /> PUBLIC WORKS
<br /> �� e.
<br /> Additional Notes: Intake Comments: Date:....................................................................................,,.,,,,,.,,,,,,,,,,,,,.,,,,,.,,,,,,,,,,,,,.,,,,,,,,..,,,,,
<br /> Worksheet Needed if:
<br /> 1\G'2lt IT _DSys Dev Eval(Util/SW)❑Traffic Mit Eval
<br /> Approved By: L, bzi^ 14-. Date: fl'�-Z\ / ,k3 (VI'�' " =DSite Work/Drainage DAddress Letter
<br /> ` ( C !DBackflow
<br /> Prevention for high hazard:
<br /> 94 ...IOW _(dental,medical,animals,mortuary,hospital,
<br /> FIRE
<br /> NT
<br /> ve
<br /> ousing)
<br /> Separate/Deferred Submittalsls ReME ed: ❑Route this folde Vttit r view at endrti---PW Review pq 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: 111 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 /> El Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance)
<br /> Approved By:VsrjGt,�. Date: ~P2 ❑ 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:� ►ta,v, Date:No ( 1 20Zjc)
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