Laserfiche WebLink
Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT # T�,_ � b 6_0 Z) <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 />Bld d /Rem Si e <br />6 <br />Garage/Accessory Struct. Size <br />O <br />Number of Stories <br />Basement <br />❑No []Yes, Fin / Unfin <br />Type of Construction <br />VB <br />Occupancy Group <br />12, Z <br />Occupancy Load <br />2— <br />Fire Sprinklers: []Update Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: ,N0 S1151'e4l <br />Fire Alarm: Update Existing ❑New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes El No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes> No <br />VALUATION CALCULATION: Total $ 7T 79.E d <br />Additional Notes: <br />Approved By Date: d <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire 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:t.f)Date: <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 />—cil it <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: (�a eX IGr �� rIhEWe,,,;,J or6t(ew-eoi <br />W� fih iS Irv► -f . I ►7t�r�or 15�� dcwv�a°�'zf°a 1 r , <br />Approved By: IUK Date: <br />PUBLIC WORKS --- <br />Intake OK by: Date: <br />.,.-... ..... ...... ......................................... ....................... ........... .......... ........................ ................... <br />Intake Comments: DPW Worksheet Needed if.• <br />=1�Sys Dev Eval OTraffic Mit Eval <br />[]Site Work or Drainage Proposed . <br />❑Backflow Prevention for high hazard: <br />'(dental, medical, animals, mortuary, hospital, <br />.supportive housing) <br />_......_...._.._.._....... __..-_._...._....-....._...... <br />- _...... __ ._.._ <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 />❑ 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 folderfor permit issuance) <br />❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: Date: <br />