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Intake &Approval Sheet (FOR PERMIT STAFF ONL)7 PERMIT# E�_?0 S <br /> BUILDING LANNiNG <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 /> Bidg/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 School impact Fee: Total $ <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 111/2022: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park impact Fee Total$ (net due affercreart for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> ---- ---- ------------- ---- ------------------------------------ <br /> Fire Alarm: Update Existing New System ❑Not Req'd Permit Techni--- cian Use Only:Appiy 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 ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2J2023 <br /> Add'1 RCW 64.55 dots required priorto final? ❑Yes []No ❑ 0%Credit-issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$Zf )60,00 Additional Notes: <br /> Approved By: 04165Date: (1 2- <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> ------=- -------- -------;:--------------- <br /> Intake Comments: ;PWWorksheetNeededif <br /> ❑Sys Dev Eval(Utivsvv) QTraffic Mit Eval <br /> Approved B <br /> Date: OS aZOO i❑Site Work/Drainage ❑Address Letter <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT ;supportive housing) <br /> .----------------------------------------- <br /> Separate i Deferred Submittals Required: ❑Route this folder for PW Review at end —PWRevievv 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 Coin% iththisfolderforpermitissuance) <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: no S :no r d 6 6 ((i <br /> Approved By: Date: Completed By'=LAA]±j�6Date; <br /> 0 b 2- 2-0 Z <br />