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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ,C 1O DO 1 <br /> BUILDING • •LANN!NG <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement <br /> ❑ Route to Commercial Building Nonresidential Use <br /> ❑ Route to Residential Building Residential Use <br /> ❑ Make this a"W" Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories "In Lieu"Fee:Type: Amount$ <br /> Basement ❑No ❑Yes, Fin/Unfin s School Impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group El Everett School Dist ❑Mukilteo Sc.:. Dist <br /> Occupancy Load Park Impact Fees for permits ap. "-• for after 1/1/2022: <br /> Fire Sprinklers: ❑Update Existing El New System El Not Req'd Park Impact Fee Total$ <br /> Reason Sprinklers Required: Fee Schedule Used For Calc -tion(Year): <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Permit Technicians:A.• y Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit- .sued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 50%Cred' -Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No 0 0%Cr dit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Additional, otes: <br /> Approved By: ` Date:7h j qt z."Z <br /> UBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Approved B Date:�/�/Z2�7 Z OSite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate/Deferred Submittals Required: El Route this folder for PW Review at end ---PW Review Worksheet <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> RI This Permit is Approved by Public Works <br /> Fire Dept. Fees: ❑ See PW Review Worksheet and associated attached items <br /> ❑ Review • As-Built Plans-NO FIRE FEE El A Separate PW Permit is Required(Permit#: PW <br /> ❑ '• al or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder • <br /> 511 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By:k U.y A,_• Date: L.O(u1 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 0 Public Works has no scope---PW Not Required <br /> ELELECTRICAL/PLU Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved B*.441"7 'Tso ,� Date: /O -20 •Zs2Z_ <br />