Laserfiche WebLink
• <br />Intake & Approval Sheet <br />(FOR PERMIT STAFF ONLY PERMIT # <br />2,l05--07-4- <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 />Id /TI/Addn/Rem Size <br />g$ '% <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />9No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System 49 Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing 1PNe,,i System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? Oyes CR No <br />Add] RCW 64.55 does required prior to final? ❑Yes LINO <br />VALUATION CALCULATION: Total $ ZO Oct-", a <br />Additional Notes: <br />Approved B M., Date: p6 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ire Alarm ❑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 />Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date:6— <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required befo a Final?, ❑Yes o <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Di t <br />Additional Notes: <br />Approved By: Date; <br />PUBLIC WORKS <br />Intake OK by; . Date: <br />:.................. W,................................. ....... .......... ..-.......... ................... W.... <br />Intake Comments: PWWorksheet Needed if: <br />OSys Dev Eval ❑Traffic Mit Eval <br />:[]Site Work or Drainage Proposed <br />OBackflow Prevention for high hazard: <br />_(dental, medical, animals, mortuary, hospital, <br />=supportive housing) <br />..,.......,.,....„......,.,.,.,.,.,.._..................,..,.,...,.,......................,.,...,,, <br />❑Route this folder for PW Review at end --- PW Review Worksheef <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 />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder Coin with this folder for permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: 10,9 -7 S F Ate,., WA-cL6 SucaG.a c C <br />Approved By: Date: p�Z� <br />