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Intake & Approval Sheet Aik, (FOR PERMIT STAFF ONLr — PERMIT # 9aA(( - 04(6, <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 />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ❑Not'Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update 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] RCW 64.55 docs required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: ate: Lk <br />FI EPARTMENT <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 />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <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 ❑Mukilteo 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 />-------------------------------------------------------------------------------- <br />Permit Technician Use Only: Apply Phase -In Credit Per EMC19.53.200 <br />❑ 100% Credit- Issued 1/1/2022 - 9/2/2022 <br />❑ 50% Credit - Issued 0/3/2022 - 6/2/2023 <br />❑ 0% Credit - Issued 6/3/2023 or later <br />Additional Notes: <br />Approved By: Date: 1l_ _ Z2, <br />UBLIC WORKS <br />Intake OK by: Date: <br />------------------------------------------ <br />Intake Comments: ;PWWorksheet Needed if., <br />El Sys Dev Eva[ (Util/SW) ❑Traffic Mit Eval <br />❑Site Work/Drainage ❑Address Letter <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <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 />El 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 />❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />[0-Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Completed By; Date: <br />