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Intake & Approval Sheet =OR PERMIT STAFF ONLY)—RIVIIT # �Pt 0-6
<br />BUILDING
<br />Intake OK by: Date:
<br />Intake Comments:
<br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp)
<br />Bldg/TI/Addn/Rem Size
<br />Garage/Accessory Struct. Size
<br />Number of Stories
<br />Basement
<br />[]No ❑Yes , Fin / Unfin
<br />Type of Construction
<br />Occupancy Group
<br />Occupancy Load
<br />Cert. of Occpuancy Required?
<br />❑No ❑Yes ❑Shell Only
<br />Code Year
<br />❑2021 112018 ❑2015
<br />Fire Sprinklers: ❑Update Existing []New System ❑Not Req'd
<br />Reason Sprinklers Required:
<br />Fire Alarm: []Update Existing []New System []Not Req'd
<br />Reason Fire Alarm Required:
<br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No
<br />Add'I RCW 64.55 docs required prior to final? []Yes ❑No
<br />VALUATION CALCULATION: Total $
<br />Additional Notes:
<br />Approved By: ' Date:
<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: Date:
<br />LUMBING
<br />Additional Notes:
<br />Approved Date; Z
<br />PLANNING
<br />Intake OK by: Assign To: Date:
<br />Intake Comments:
<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 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 />Park Impact Fees for permits applied for after 11112022:
<br />Park Impact Fee Total $ (net due after credit for existing uses)
<br />Fee Schedule Used For Calculation (Year):
<br />Additional Notes:
<br />Approved By: Date:
<br />PUBLIC WORKS
<br />Intake OK by: Date:
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<br />Intake Comments: IPW Review & Worksheet Needed if.,
<br />IN
<br />Dev Eval :
<br />❑Water ❑Sewer []Storm
<br />OTraffic Mitigation Eval
<br />I
<br />3[]Site Work/Drainage (shown/triggered)
<br />❑Address Letter
<br />❑Backf ow 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 />❑ Is located in this folder
<br />❑ Is in a Separate Green Folder Coin with this folderfor 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 />Additional Notes:
<br />Completed By: Date:
<br />
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