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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# M <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 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 permit 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 ❑Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire A(ar n Required: El 100%Credit-Issued 1/1/2022-9/2/2022 <br /> ROW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No L7 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add']RCW 64.55 docs required prior to final? ❑Yes ❑No 1:1 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total $ Additional Notes: <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ©Traffic Mlt Eval <br /> Approved By: - Date: Llslte Work or Drainage Proposed <br /> ill 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 and ---PW Review Worksheet <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: El 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 doln 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'IPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />