Laserfiche WebLink
Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#t23 V) 052— <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required(Pre-Insp) Overlay/Agreement y <br /> Bldg/TI/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size 605 Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: /y <br /> Basement No Yes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction I- Planning/Landscape Inspection Required before Final? JoYes []No <br /> Occupancy Group I F-L. "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load T� — School Impact Fee: Total $ Z� <br /> Cert.of Occpuancy Required? []No ®Yes []Shell Only Calculated: /y /Z/ Credit: —�-- <br /> Code Year ❑2021 02018 112015 []Everett School Dist mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing []New System QNot Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: []Update Existing ❑New System 0Not Req'd Fee Schedule Used For Calculation(Year): 3 <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? []Yes 13 No <br /> Add'I RCW 64.55 docs required prior to final? []Yes rQNo Additional Notes: <br /> VALUATION CALCULATION: Total$�S��f�Q <br /> Approved By: ���L�Date: /_ /C/- Z.7 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: I PW Review&Worksheet Needed if:---~ <br /> ❑Sys Dev Eval: <br /> Additional Notes: I ❑Water ❑Sewer []Storm <br /> ❑Traffic Mitigation Eval <br /> Approved By: C, Date: k,,) 7 ❑Site Work/Drainage(shown/triggered) <br /> r ❑Address Letter <br /> FIRE DEPARTMENT ❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: (dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> ❑Fire Sprinklers []Fire Alarm ❑Other: <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join With this folderfor permit issuance) <br /> Approved By: Co Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By: Date: vV IZ z <br />