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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT # F> <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 />Bldg/TI/Addn/Rem Size <br />(� <br />Garage/Accessory Struct. Size <br />Number of Stories <br />3 <br />Basement <br />E]No ❑Yes , Fin / Unfin <br />Type of Construction <br />J,L, <br />Occupancy Group <br />C. <br />Occupancy Load SLL- <br />Fire Sprinklers: []Update Existing Mew System EJNot-Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System Mot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes 1ZNo <br />VALUATION CALCULATION: Total $ (2, ecn <br />Additional Notes: <br />Approved By: Date: <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 - NO FIRE FEE <br />❑ Review/ inspection Scope -ADD FIRE FEE <br />Approved By: Date: <br />EL.i~CTRICALIRLUM.BING <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 />PlanninglLandscape Inspection Required before Final? ❑Yes []No <br />"In Lleu" 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 11112022: <br />Park Impact Fee Total $ / (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />................................................................................ <br />Permit Technician Use Only: Apply Phase -In Credit Per ENMC19.53.200 <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: - N - Cali CZ a It WIV <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />......................................... <br />Intake Comments: :PW WorksheetNeeded if. <br />❑Sys Dev Eval (Util/sM QTraffic Mit Eval <br />)]Site Work/Drainage ❑Address Letter <br />;1113ackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />rr s <br />[Route this folder for PW Review at end-- PW Review 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 folder for permit issuance) <br />❑ Will be issued Separately (Separate Green Folder, PW issued ahead of Bldg) <br />fg+ublic Works has no scope — PW Not Required <br />Additional Notes: <br />Completed 13y: Date: 1* s 1Z to I L61-3 <br />'3 <br />