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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 3 0 3 —0G7 <br /> BUILDING , •WNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <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/Tl/Addn/Rem Size 0 IA Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? QYes ONo <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ONo IYes, Fin c School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group .j2C. ❑Everett School Dist OMukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers:OUpdate Existing O ��ppNew System ►ANot*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 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? QYes r2rNo ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? Q,Yes ONo CI 0%Credit-Issued 6/3/2023 or later <br /> J <br /> VALUATION CALCULATION: Total$ �[t1! /k 7 Additional Notes: <br /> OvMdat`°'' 31.11 Approved By: "6 Date: 9/( /�Z.2� <br /> PUBLIC WORKS • . <br /> • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if <br /> ❑Sys Dev Eval(Util/sW)❑Traffic Mit Eval <br /> Approved By: € 4?Z' Date: 00IM- ❑Site Work/Drainage ['Address Letter <br /> DBackflow 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 /> OFire Sprinklers ❑Fire Alarm OOther: ®This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND OCreate Green Folder OSubmitted Previously ❑Deferred <br /> O This Permit is Approved by Public Works <br /> Fire Dept.Fees: O See PW Review Worksheet and associated attached items <br /> O Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#: PW ) <br /> O Minimal or No Fire Scope-NO FIRE FEE AND O Is located in this folder <br /> O Review/Inspection Scope-ADD FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date: O Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> -Public Works has no scope--PW Not Required <br /> ELECT.RIC.AL/RLUMBING Additional Notes: 654"r9A?.• ,, we woe. w Y <br /> Additional Notes: <br /> Approved By: Date: Completed L Date: 3 r22.Ito z-3 <br />