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Intake & Approval Sheet (FOLPERMIT STAFF ONLY} PERMIT#13,p,3o4 V LfL( <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 />Bldg/Ti/Addn/Rem Size <br />1722 <br />Garage/Accessory Struct. Size <br />Zf <br />Number of Stories <br />Basement <br />ONo ElYes , Fin / Unfin <br />Type of Construction <br />%ZC <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: E]Updat, Mdating MfNew System ❑Not Req'd <br />Reason Sprinklers Required: p �--f <br />Fire Alarm: ❑Update Existing ❑New System MNot Req'd <br />Reason Fire Alarm Required: <br />RCW64.55MFworksheetreq'dfor permit? ElYes El No <br />Add'I RCW 64.55 does required pdorto final? ElYes ONo <br />VALUATION CALCULATION: Total $ 3 / {—j 520 <br />Additional Notes: <br />Approved By: Date: % <br />. FIRE DEPARTMENT <br />Separate! Deferred Submittals Required: <br />,Fire Sprinklers DFireAlamn ❑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 />19 Review/ inspection Scope -ADD FIRE FEE <br />Approved By: Date: 3 <br />ELECTRICAL/RLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLA <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 />PlanninglLandscape inspection Required before Final? DYes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 9 <br />Calculated: I�T �� Credit: <br />DEverett school isD t E Mukilteo School Dist <br />Park Impact Fees for permits applied for after 11112022, <br />Park Impact Fee Total �­. �1, (net due after creditfor existing uses) <br />Fee Schedule Used For Calculation (Year): Z a y <br />-- ------ --------------------- ---- ----- ---------- -------------------- -- <br />PermitTechnician Uss Only: Apply Phase -In Credit Per EMC19,53.200 <br />❑ 10 % Credit- Issued VW022 - 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: <br />PtIBLIG WORKS <br />Intake OK by: Date: <br />............................ <br />Intake Comments; :PW WorksheetNeededif. <br />USys Dev Eval (util/sM ElTraffic Mit Eval <br />:Site Work/Drainage I_7Address Letter <br />;IlBackflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />❑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 />MA Separate PW Permit is Required (Permit #.' PW`d 0�_ $ 9 _) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder loin w th this folder for permit issuance) <br />19 Will be issued separately (separate Green Folder, PW Issues d ahead Bldg) <br />❑ Public Works has no scope — PW Not Required <br />Additional Notes: <br />Completed By: Date: 5 <br />