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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # Qlf! Ois <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />BldgTrl/Addn/Rem Size <br />r <br />Garage/Accessory Struct. Size <br />Al A <br />Number of Stories <br />% <br />Basement <br />fJNo <br />❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />�Z- <br />Fire Sprinklers: 19update Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire -Alarm: allpdate Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF Worksheet req'd for permit? ❑Yes No <br />Add'1 RCW 64.55 does required prior to final? ❑Yes ;&No <br />VALUATION CALCULATION: Total $ /S'O ,000.00 <br />Additional Notes: <br />Approved Date:0,;- Z3 773 <br />FIRE DEPARTMENT <br />Separate! Deferred Submittals Required - <br />[]Fire Sprinklers ❑Fire Alarm []Other: <br />Additional Notes: , <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - N- O FIRE FEE <br />Eg�Review inspection Scope DD FIRE FEE'_" <br />Approved By: C6 Date: ,LJ 3 <br />ELECTRICAL/l?LUMBING <br />Additional Notes: <br />Approved By: Date: <br />ANNiNG <br />Intake OK by; Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No, of Dwelling Units: <br />Total No, of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated:. Credit: <br />❑Everett School Dist ❑Mukiiteo School Dist <br />Park Impact Fees for permits applied for after 1/112022: <br />Park Impact Fee Total $ (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Permit" Technician Use Only: Apply Phase -In Credit Per EMCIY53.200 <br />❑ 100% Credit- Issued 1/1/2022 - 9/2/2022 <br />❑ 50% Credit - Issued 9/3/2022 - 6/2/2023 <br />❑ 0% Credit - Issued 6/3/2023 or later <br />Additional Notes: <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: G�Iq�'leS IPW Worksheet Needed if- <br />% m <br />qcK j,�y� p rwW r1' ;CISys Dev Eval (Util/sW) []Traffic MitEval <br />6L.. P�WI�y� �{�IG �I GG "USiteWork/Drainage ElAddressi-etter <br />�i i , /Kt o " 0��) ; ClBackflow Prevention for high hazard: <br />Asti ow - :(dental, medical, animals, mortuary, hospital, <br />4)XS . ;supportive housing) <br />~ Route this folder for PW Review at end -- PW Revfew Worksheet- <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder [Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ is in a Separate Green Folder (join with this folderfor permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW Issued ahead of Bldg) <br />❑ Public Works has no scope -- PW Not Required <br />Additional Notes: <br />N W 4d i I ( ill rtu` Ido 1, . <br />Completed By: Date: 0 q (I 12,o2,3 <br />