Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# '3a 30't'O 03 <br /> BUILDING I INING <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 /> BldgITl/Addn/Rem Size 2'y /, Total No.of Dwelling Units: <br /> Garage/Accessory Struct. Size (IP/ Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Number of Stories / "In Lieu"Fee:Type: Amount$ <br /> Basement c_2No ❑Yes, Fin/Unfin School Impact Fee: Total $ <br /> Type of Construction Zit r Calculated:_ W5(0,.oU Credit: <br /> Occupancy Group 2!2 C Everett School Dist ❑Mukilteo School Dist <br /> Occupancy Load -‘ Park Impact Fees for permits applie for after 1/112022: <br /> Fire Sprinklers: DUpdate Existing ❑New System ONot*Req'd Park impact Fee Total$ 3/er0 (net due after credit for existing uses) <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): 2 o2.3 <br /> Fire Alarm: DUpdate Existing New System _Plot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes E No ❑ 50%Credit-Issued d/3/2022-6/2/2023 <br /> Add'1 RCW 64.55 does required prior to final? DYes tia No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ 3s1 k Additional Notes: <br /> /g CX/1 (= • <br /> Approved By: Date: 1/— 2 .) <br /> Lai/k <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Day Eval(Util/SW) OTraffic Mit Eval <br /> Approved Pky;, �,y . - Date: is/2g4/Lb7,3 ❑Site Work/Drainage DAddress Letter <br /> ❑Backflow 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 end ---PW Review 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 /> U.This Permit is Approved by Public Works <br /> Fire Dept. Fees: M 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 2304.0 (4 ) <br /> inimal or No Fire Scope-NO FIRE FEES AND El Is located in this folder <br /> ion Scope EE It Is in a Separate Green Folder coin with this folder for permit issuance) <br /> Approved By ,, -c'owy\ Date: 4/- ,'j lig 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: <br /> Approved By: Date: Completed By�� Date: o4lji f zo23 <br />