Laserfiche WebLink
Intake & Approval Sheet (FOR PERMIT STAFF ONLY] PERMIT # oE _ V I <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg I Addn/Rem Size <br />(111). no 0 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />1 'r L <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />V <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />MNo []Yes []Shell Only <br />Code Year <br />2021 112018. 112015 <br />Fire Sprinklers: ❑Update Existing ❑New System E'Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System ENot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? []Yes 5U No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes QNo <br />VALUATION CALCULATION: Total $� <br />Additional Notes: <br />Approved By; Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers []FireAlarm ❑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: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by:__.a— Assign To:JQS5 Date: 15 Z Z4A <br />Intake Comments: <br />Zone <br />%A'S <br />Overlay/Agreement <br />A it A 4 AGA <br />Nonresidential Use <br />H� h ��ndvS�nri0.� <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? []Yes RNo <br />"In Lieu" Fee: Type: Amount $ d <br />School Impact Fee: Total $ 10 <br />Calculated: Credit: <br />[]Everett School Dist ❑Mukilteo School Dist <br />Park Impact Fees for permits applied for after 1/112022: <br />Park Impact Fee Total $ D (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: ZN <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PWRevlew& Worksheet Neededff.- <br />[]Sys Dev Eval <br />❑Water []Sewer []Storm <br />!E]Traffic Mitigation Eval <br />USite Work/Drainage (shown/triggered) <br />ElAddres, Letter <br />i <br />I OBackffow Prevention for high hazard: <br />((dental, medical, animals, mortuary, <br />hospital, supportive housing) <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 fully digital <br />Ells located in this folder <br />❑ Is in a Separate Green Folder (join 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 on this permit --- PW Not Required <br />dditional Notes: <br />Completed By: Date: <br />