Laserfiche WebLink
Intake &Approval Sheet �r'OR PERMIT STAFF ONLI) <br />_^ERMIT # <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 />0No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />[E]No ❑Yes []Shell Only <br />Code Year <br />1:12021 ®2018 112015 <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 does required prior to final? ❑Yes ISNo <br />VALUATION CALCULATION: Total $ QL <br />Additional Notes: <br />Approved By: L Date: <br />'FIRE DEPARTMENT <br />Separate / Deferred b Smittals 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 />0-Review / Inspection Scope - ADD FIRE FEE <br />Approved By: �jbWVM Date: <br />ELECTRI 'ALIPLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING : <br />Intake OK by: Assign To: Jess Date: } 2 <br />Intake Comments: <br />Zone <br />M. V <br />Overlay/Agreement <br />NIA <br />Nonresidential Use <br />O 4 i Ge 5 <br />Residential Use <br />NJA <br />Proposed No. of Dwelling Units: <br />M A <br />Total No. of Dwelling Units: <br />14 /A <br />Planning/Landscape Inspection Required before Final? ❑Yes MNo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ O <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 (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: ate: (Z f 3 13 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Review & Worksheet Needed if: <br />❑Sys Dev Eval : <br />❑Water ❑Sewer []Storm <br />ElTrafric Mitigation Eval <br />[]Site Work/Drainage (shown/triggered) <br />(]Address Letter <br />❑Backflow 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 (join with this folderforpermit issuance) <br />❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />lPublic Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />o all +V*tV.%W <br />Completed By: <br />Date: \ I I I-) <br />I 20 Z <br />a <br />