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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT <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 �s <br /> ❑ Make this a"W"Permit Proposed No.of Dwelling Units: <br /> Bldg/TI/Addn/Rem Size 7 -I 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 School Impact Fee: Total $ <br /> Type of Construction t2�*t— Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/112022: <br /> Fire Sprinklers: []Update Existing El New System Not Req'd Park Impact Fee Total$ (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: []Update Existing ❑New System Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 _ W <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 2T No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 does required prior to final? []Yes VNo ❑ 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 'i T QGa Additional Notes: <br /> say �l � rr'' <� I <br /> 'W 146 1 KK �/l_ Approved By: Date: <br /> I3 tiK6 = �i�131K <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: SPIN Worksheet Needed if.• <br /> i❑Sys Dev Eval(util/sw)❑Traffic Mit Eval <br /> Approved By: L47Z;F- Date: /,I-- 1L3 (❑Site Work/Drainage ❑Address Letter <br /> I❑Backflow Prevention for high hazard: <br /> ;(dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT Isupportivehousing) <br /> Separate I 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: , 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 Z.90S U07 ) <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND 91s located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE . ❑ Is in a Separate Green Folder doln with this folder for 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 /> ELECTRICALIPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: 6,flis 7.4tig <br />