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(l> <br /> Intake & Approval Sheet -OR PERMIT STAFF ONLY 'ERMIT# c� D <br /> BUILDING PLANNING <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 Jv /5'/_11f Total No. of Dwelling Units: <br /> Garage/Accessory Struct.Size A11A Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories f "In Lieu"Fee:Type: Amount$ <br /> Basement No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction &J6 Calculated: Credit: / <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load 2 Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: []Update Existing ❑New System Not Req'd Park Impact Fee Total$ <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing El New System' L]tNot Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? []Yes No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? []Yes No ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ J DUV,CA) A <br /> ddition Notes <br /> J <br /> pproved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: _Date: <br /> Intake Comments: PIN Worksheet Needed if., <br /> t <br /> []Sys Dev Eval []Traffic Mit Eval <br /> Approved ByzKDate:(�J []Site Work or Drainage Proposed <br /> I❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT (supportive housing) <br /> Separate/Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> ❑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 /> This Permit is Approved by Public Works <br /> Fire Dept. Fees: 54 See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> Z[Winimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Qoln with this folder for permit Issuance) <br /> Approved By: Date: �3 El Will be issued separately(separate Green Folder,PW Issued ahead of Bldg) <br /> ❑ Public Works has no scope--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: t2 tL ?�L3 <br />