Laserfiche WebLink
Intake & Approval.Sheet <br />AERMIT STAFF ONLY) PI/ Y SIT # � � `c �e) <br />BUILDING <br />intake OK by: pate: <br />intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />13ld91Tl/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />IflNo QYes , Fin 1 Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />RINo QYes QShell Only <br />Code Year <br />Q2021 2018 02015 <br />Fire Sprinklers:0-Update Existing QNew System IRNpt Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: QUpdate Existing QNew System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MRworksheet req'd for permit? QYes No <br />Add'I RGW 64.55 does required prior to final? Dyes gLNO <br />wwxrIoN CALCULATION: Total $- !;�Q!�® <br />Additional Notes: <br />Approved By: Date. <br />FiRJj DE0ARTMJ�iNT° <br />Separate I Deferred Submittals Required: <br />QFire Sprinklers ❑Fire Alarm QOther. <br />Additional Notes: <br />Fire Dept. Fees: <br />Q Review of As-13uilt Plans -NO FiRE FEE <br />Q Minimal or No Fire Scope - NO FIRE FEE <br />Review/ Inspection Scope -ADD FIRE FEE <br />Approved By; Date: <br />ELEG-TRICALlALUMBING <br />[Approved <br />dditional Notes: <br />By: Date: <br />PLANNING <br />Intake OK by: —� — Assign Toje SS Date-1/slim <br />intake Comments: <br />Zone <br />Overlay/Agreement <br />A (Ar f- A,C A <br />Nonresidential Use <br />H i h Ihdusirc-11a.1 <br />Residential Use <br />— <br />Proposed No. of Dwelling Units: <br />—^ <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? QYes XNo <br />"in Lieu" Fee: Type: Amount $ d <br />School -Impact Fee-, Total $0 <br />Calculated: Credit: <br />QEverett School Dist QMukiltea School Dist <br />Park Impact Fees for permits applied for after 11112022: <br />Park impact Fee Total $ 0' .(not due after credit for exisfing uses) ' <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: Z <br />U <br />' PUB.L[C till®R,KS <br />Intake OK by: Date: <br />Intake Comments: AWRevPery & INorksheef Needed if• <br />(]Sys Dev Eva[ : <br />ClWater I ]Seiner ❑Storm <br />tOTraffic Mitigation Eval <br />£EISite Work/Drainage (shownitriggered) <br />!E]Address Letter <br />t <br />1 bBackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />Ehospital, supportive housing)' <br />r <br />Q This Permit is Approved by Public Works <br />Q See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit#. PW ) <br />AND Q Is fully digital <br />Q Is located in this folder <br />Q Is in a Separate Green Folder aotnwiththrsfoiderforpermli.issuance) <br />Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />VQ <br />Public Works has. no scope on this permit--- PW Not Required <br />ddltlonal Notes: <br />b <br />Completed By. <br />Date: <br />ELI <br />