Laserfiche WebLink
Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT # R P- 3 ©7 <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />S <br />Garage/Accessory Struct. Size <br />3 S <br />Number of Stories <br />Basement <br />o ❑Yes , Fin / Unfin <br />Type of Construction <br />Z � L <br />Occupancy Group <br />7-9 L <br />Occupancy Load <br />7T L <br />Fire Sprinklers: El Update Existing []New System VLA 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 fina . <br />VALUATION CALCULATION: T $ v <br />6b 7, gl6 (50­1x-) <br />�7X d0v) <br />Additional Notes: <br />Approved By. �1 . Date: / }tiy <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: —,,2L- <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: 10 20 <br />Intake Comments: <br />Zone <br />- 2, <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />$FQ, <br />Proposed No. of Dwelling Units: <br />} 1 <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes No <br />"In Lieu" Fee: Type: Am unt $ <br />School Impact Fee: Total $ Z <br />Calculated: Credit: <br />Everett School Dist ❑Mukilte School Dist <br />or after 1/112022: <br />Park Impact Fees for permits appt3l-r <br />Park Impact Fee Total Q R� <br />Fee Schedule Used For Calculation (Year): 7 L <br />Permit Technicians: Apply Credit Per EMC19.53.200 <br />❑ 100% Credit- Issued 1/l/2022 - 9/2/2022 <br />❑ 50% Credit - Issued 9/3/2022 - 6/2/2023 <br />❑ 0% Credit - Issued 6/3/2023 or later <br />Additional Notes: <br />Approved By: �- Date: tv 2 o Z <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: <br />,PW Worksheet Needed if. <br />• <br />El Sys Dev Eval ❑Traffic Mit Eval <br />i <br />I❑Site Work or Drainage Proposed <br />j❑Backflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />supportive housing) <br />❑ Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder []Submitted Previously ❑Deferred <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 23I O — O f f i) <br />AND Is 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 --- PW Not Required <br />Additional Notes: <br />Approved By: Date: p D <br />0 <br />