Laserfiche WebLink
Intake & Approval Sheet (FOR PERMIT STAFF ONLI9 <br />PERMIT <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 />i. <br />Garage/Accessory Struct. Size <br />U{ g <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />'-(� <br />Occupancy Group <br />Occupancy Load <br />t <br />Cert. of Occpuancy Required? <br />El No Yes ❑Shell Only <br />Code Year 102021 <br />D2018��❑2015 <br />Fire Sprinklers: ❑Update Existing ❑New System 13NotReq'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System QNot 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 1Plo <br />VALUATION CALCULATION: Total .` 'L , 0 <br />� 236 - co <br />4(dj )C(aLi �� ��� 3 <br />11� <br />Additional Notes: <br />Approved By: Date: I J <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El 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 />ELECTRICAUPLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />ryi <br />Nonresidential Use <br />�— <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before <br />final? Yes PNo <br />"In Lieu" Fee: Type: Amount <br />School Impact Fee: Total $ ? <br />Calculated: Cn — Credit: <br />❑Everett School Dist ❑Mukilteo chool Dist <br />Park Impact Fees for permits applie for after 1/112022: <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:- - c <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: iPW Review & Worksheet Needed if.• <br />❑Sys Dev Eva <br />i ❑Water ❑Sewer ❑Storm <br />i <br />3 ❑Traffic Mitigation Eval <br />i <br />❑Site Work/Drainage (shown/triggered) <br />❑Address Letter <br />i ❑Backflow Prevention for high hazard: <br />!(dental, medical, animals, mortuary, <br />;hospital, supportive housing) <br />MIThis Permit is Approved by Public Works <br />V�See PW Review Worksheet and associated attached items <br />KSeparate PW Permit is Required (Permit #: PW 2- <br />AND ❑ Is fully digital <br />Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ WIII 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: 6 S /? 1- Z "� <br />