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Intake &Approval Sheet (FOR PERMIT STAFF ONLr PERMIT#t?`i — -3
<br /> BUILDING PLANNING
<br /> Intake OK by: Date: Intake OK by. l Assign To:Jec Date: 2
<br /> Intake Comments: Intake Comme s:
<br /> Zone R-2
<br /> Overlay/Agreement S1cLew \lc_ 9 r-;ors}
<br /> ri
<br /> ❑ Route to Commercial Building Nonresidential Use M/A
<br /> ❑ Route to Residential Building Residential Use DvPlex Z-un►kf
<br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: NSA
<br /> Bldg/TI/Addn/Rem Size Total No. of Dwelling Units: Z.
<br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ®No
<br /> Number of Stories "In Lieu" Fee:Type: Amount$ O
<br /> Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ a
<br /> Type of Construction Calculated: Credit:
<br /> Occupancy Group []Everett School Dist ❑Mukilteo School Dist
<br /> Occupancy Load r Park Impact Fees for permits applied for after 1/112022:
<br /> Fire Sprinklers: ❑Update Existing ❑New System RNot Req'd Park Impact Fee Total$ (net due after credit for existing uses)
<br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year):
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<br /> Fire Alarm: ❑Update Existing ❑New System LRNOt Req'd Permit Technician Use Only:Apply Phase-In 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 EfNo ❑ 50%Credit-Issued 9/3/2022-6/2/2023
<br /> Add'I RCW 64.55 dots required prior to final? ❑Yes ETNo ❑ 0%Credit-Issued 6/3/2023 or later
<br /> VALUATION CALCULATION: Total$ i,00ic� Additional Notes:
<br /> Approved By: Date:i5/z/Z 3
<br /> PUBLIC WORKS
<br /> Additional Notes: Intake OK by: Date:
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<br /> A:.�t.St�C� C�cT �►1!� 6t,.'1L_Y "" O Intake Comments: iPW Worksheet Needed if.,
<br /> Ce!J`� v��lOcJ �� t��� ;❑Sys Dev Eva[(Utiiisw)❑Traffic Mit Eva[
<br /> Approved By: Date: L4 'Za 7sZ3 i❑Site Work/Drainage ❑Address Letter
<br /> ❑Backflow Prevention for high hazard:
<br /> (dental,medical,animals,mortuary,hospital,
<br /> FIRE DEPARTMENT Isupportivehousing)
<br /> L...............,....._,.......,....,....._..................__...........,..,.,,..,.................
<br /> ..,,..,,,
<br /> Separate/Deferred Submittals Required: El 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: ❑ 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 /> ❑ Minimal 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[join with this folderfor permit issuance)
<br /> Approved By: Date: ❑ 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: r=4aj —
<br /> Approved By: Date: Completed By-juaUL, Date: 0 L
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