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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# gaa0g ( � <br /> BUILDING • •ANNiNG 162,1Scon5 <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone ( U) <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bidg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories "in Lieu"Fee:Type: Amount$ <br /> Basement El No ❑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 Park Impact Fees for permits applied for after 111/2D22: <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 ONew System ONot Req'd Permit Technician Use Only:Apply Phase-in Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: El 100%Credit-issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑ 50%Credit-Issued 0/3/2022-6/2/2023 <br /> Add'l RCW 64.55 dots required prior to final? ❑Yes ❑No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Additio I Note : <br /> �� la\ 3/2I /7s <br /> Approved By: Date: <br /> PUBLIC WORKS • . <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if• <br /> ❑Sys Dev Eval(Utii/SW) OTraffic Mit Eval <br /> Approved B : / Date:Oy /�e OSite Work/Drainage DAddress Letter <br /> �/ Z3 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate I Deferred Submittals Required: ❑Route 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 OSubmitted 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(loin with this folder for permit issuance) <br /> Approved By: i f2 �>,,tyl Date: 1�-� El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> �✓ Public Works has no scope---PW Not Required <br /> ELECTRICAL/RLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed 851:�p --'"Date: 312?/zo23 <br />