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Intake & Approval Sheet <br />I <br />(FOR PERMIT STAFF ONLI9 <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 />Bid rrl/Addn/Ram Size <br />Garage/Accessory Struct. Slze <br />Number of Stories <br />Basement <br />IgNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Q <br />Occupancy Group <br />14- <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 Re uired: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes MNo <br />Add'I RCW 64.55 does required prior to final? ❑r Yes No <br />VALUATION CALCULATION: Total $ 7JV 000,00 <br />Additional Notes: <br />Approved Date: OX8 7 L7 <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 />k11 Minimal or No Fire Scope - NO FIRE FEE <br />Review / Inspection Scope - ADD FIRE FEE <br />proved By: Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />)ERMIT# nL3-06-0oll <br />PLANNING <br />Intake OK by: Assign To: Jess Date: % /3 Z$ <br />Intake Comments: <br />Zone <br />M U <br />Overlay/Agreement <br />tA,Acn p¢d, can ulo� <br />Nonresidential Use <br />Peka.tl sakes secvlce.s <br />Residential Use <br />WA <br />Proposed No. of Dwelling Units: <br />M /A <br />Total No. of Dwelling Units: <br />NIA <br />Planning/Landscape Inspection Required before Final? ❑Yes ONO <br />"In Lieu" Fee: Type: Amount $ D <br />School Impact Fee: Total $. <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 111/2022: <br />Park Impact Fee Total $ O (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Permit Technician Use Only: Apply Phase -In Credit Per EMC19.63.200 <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: 7�13�2'3 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: JPW Worksheet Needed lf.• <br />❑Sys Dev Eval (I101/5W) ❑Traffic Mit Eva] <br />11381te Work/Dminage ❑Address Letter <br />j❑Backflow Prevention for high hazard: <br />Udental, medical, animals, mortuary, hospital, <br />isupportive housing) <br />❑Route this folder for PW Review at end --- PW Revlew 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 0oln vdth this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW Issued ahead of Bldg) <br />5ZPublic Works has no scope --- PW Not Required <br />Additional Notes: <br />Completed B . Date: b6 6 2 <br />