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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ') ✓C," / <br /> BUILDING PLA !G <br /> Intake OK by: Date: Intake OK by: UL Assign To: ti I-C>o,9 _ Date: 1/I I/2-3 <br /> Intake Comments: Intake Comments: <br /> Zone J2-- <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use 0-1- Titrrl I 1-brvit <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size j(3 S F Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size DE. Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories i "In Lieu"Fee:Type: Amount$ <br /> Basement Vg.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 LoadL. Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing ONew System I41Not 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 IgNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ❑ 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'l RCW 64.55 docs required prior to final? ❑Yes '❑No 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ t l 61 co.a Additional Notes: 2- poi Sri' s pvtce.S I�s(Vlrrol 1 pWl av'-e -►W <br /> r �3 fj�� 61,13x <br /> `1 j�- S-itt*PekScri on sh;f-1 nvt wore) ptir i s-eS <br /> b . <br /> Approved By: Date: '� /I I 'wZ�j <br /> VO 1 a PUBLIC WORKS • <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if- <br /> $rtb s� <br /> 5rSys Dev Eval(Util/SW) OTraffic Mit Eval <br /> Approved By: C QN. Date: a 1 fa 4 Mite Work/Drainage (Address Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT • supportive housing) <br /> Separate!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 OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> OThis Permit is Approved by Public Works <br /> Fire Dept.Fees: IXSee 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: Date: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope---PW Not Required <br /> ELECTRICALIPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed 13 Date: b44204 <br />