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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # BIZ/ ( I - P °I <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 />I I/Addn/Rem Size <br />1'}4(0 Sir <br />ara ccessory Struct. Size <br />563 SIF <br />Number of Stories <br />1 <br />Basement <br />IRlo ❑Yes , Fin / Unfim <br />Type of Construction <br />T�L <br />Occupancy Group <br />S4-e— <br />Occupancy Load <br />5::F-c <br />Fire Sprinklers: []Update Existing ❑New System of Req'd <br />Reason Sprinklers Required: la A <br />r�. <br />Fire Alarm: El Update Existing ❑New System L^INot Req'd <br />Reason Fire Alarm Required: N A <br />RCW 64.55 MF Worksheet req'd for permit? ❑Yes ® No <br />Add] RCW 64.55 does required prior to final? ❑Yes PRNo <br />VALUATION CALCULATION: Total <br />L I v 11J L, - 1'ql 6 SF (5—D Sf ^Jtz84, i <br />6AA1-AL t- - 503 SF@.. � 33,198 <br />Additional Notes: <br />Approved By: e 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 />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />)LANNING <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 />El Everett School Dist ❑Mukiiteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total $ (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />.....•--------------- <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 9/312022 - 6/2/2023 <br />❑ 0% Credit - Issued 6/3/2023 or later <br />Additional Notes: <br />a -22 <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date:]?—! A 12-622- <br />Intake Comments: ; PW Worksheet Needed if: <br />�QQpn ytALLM ;,�,IrSys Dev Eval (110118W) t&rafic Mit Eval <br />: N(Slte Work/Drainage DAddress Letter <br />eY 1 W `���� <br />�,-/� , <br />Ir��JIa"�'fl 4WD" ; El Backflow Prevention for high hazard: <br />:(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />......................................... <br />El 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 />CAA Separate PW Permit is Required (Permit #: PW 2212'oti6 ) <br />AND Is located 4+44is4eki&r-11% <br />Is in a Separate Green Folder 0oin with this folder for 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 Notts; _ n, ,1 2nJ �-Z-�P <br />iW L <br />Completed By:YPi <br />Date: 171 <br />Z' <br />&I <br />