Laserfiche WebLink
Intake $ Approvai Sheet <br />(FOR PERMIT STAFF ONLY) <br />°"line. Arp / RiNullPla* <br />PERMIT #t Z ' I� i <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bidg/rl/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />[]No ElYes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Cart. of Occ uancy Required? <br />[]No 11Yes []Shell Only <br />Code Year <br />1112021 [12018.112015 <br />Fire Sprinklers: ❑Update Existing ONew System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing1lNew System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? 11Yes ❑ No <br />Add'I RCW 64.55 does required priorto final? 11Yes ❑No <br />VALUATION CALCULATION: Total$ <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑FireSprinkiers ❑FlreAlarm ❑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 />ELEGTRICAL/P. LUMBING <br />Additional Notes: <br />Approved By: Date; 3 `L02 <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? 11Yes []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 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: <br />PUBLIC WORKS <br />Intake OK by: <br />Date: <br />Intake Comments: <br />PWRsvlewd Worksheet Needed1k' <br />OSys Dev Eval : <br />ElWater ❑Sewer ❑Storm <br />❑Traffic Mitigation Eval <br />❑Site WorkiDralnage (shown/(iggered) <br />❑Address Letter <br />ElBackflow 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 goin wi(h this folderfor permit issuance) <br />❑ Will 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 />