Laserfiche WebLink
Intake & Approval Sheet <br />3�GJ- <br />(FOR PERMIT STAFF ONLY) 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 />Garage/Accessory Struct. Size <br />Number of Stories <br />IV <br />Basement <br />❑No ❑Ye , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cert. of Occpuancy Required`? <br />j6No ❑Yes []Shell Only <br />102021 <br />Code Year <br />_M2018 112015 <br />Fire Sprinklers: ❑Update Existing ❑New System ®Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System 10 Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ErNo <br />Add'I RCW 64.55 docs required prior to final? ❑Yes No <br />VALUATION CALCULATION: Total $ Uc0 <br />Additional Notes: na 'W07- J <br />Approved By: 1 Date: <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 />'ELECTRICAL/PLUMBING <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 />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: ... _ <br />. <br />Intake Comments: PW Review & Worksheet Needed ih <br />[]Sys Dev Eval : <br />❑Water ❑Sewer ❑Storm <br />�0Traffic Mitigation Eva[ <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 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: <br />