Laserfiche WebLink
Intake & Approval Sheet (FO�PERMIT STAFF ONLY) <br />PERMIT# R,,�3o4 ro t-tV <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 />Z <br />Garage/Accessory Strout. Size <br />Number of Stories <br />Basement <br />ONo DYes , Fin / Unfin <br />Type of Construction <br />/ZC <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: []Update� dstfng Maw System f]NotReq'd <br />Reason Sprinklers Required: 04 �--f <br />Fire Alarm: ❑Update Existing ❑New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW64.55MFworksheetreq'dfor permit? DYes M No <br />Add'] RCW 64.66 docs required pdorto final? ElYes ONo <br />VALUATION CALCULATION: Total <br />Additional Notes: <br />Approved By: Date: 7 11{ L3 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />,Fire Sprinklers ❑FireAlarm 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: 3 <br />ELECTRICALIPLUMBING <br />Additional Notes: <br />Approved By- Date: <br />PLANWb 1A ART <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? ElYes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ L <br />Calculated: Credit: s! <br />❑Everett School Dist gMukiiteo School Dist <br />Park Impact Fees for permits applied for after 1/1/2022: <br />Park Impact Fee Total 0 . (net due after credit For existing uses) <br />Fee Schedule Used For Calculation (Year): % a <br />------ -------------------------------------------------•-------------•-------- <br />Permit Technician Use Only: Apply Phase -In Credit Per EMC79.63.200 <br />❑ 100% Credit - Issued 1/1/2022.9/2/2022 <br />❑ 60% Credit - Issued 9/3/2022 - 602023 <br />❑ 0%Credit -Issued 6/3/2023 or later <br />Additional Notes: <br />Approved By: <br />PUBLIC WORKS -' <br />Intake OK by: Date: <br />Intake Comments: :PW WorksheetNeeded if. <br />;QSys Dev Eval (UuusW) OTraffic Mit Eva[ <br />iElSlte Work(Drainage LlAddress Letter <br />ClBackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />.......... .......... ............ ..•-._-._ <br />❑Route this folder for PW Review at end —PWRevfewWorksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND El Create Green Folder ElSubmitted Previousfy ElDeferred <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />C.A Separate PW Permit is Required (Permit #: PWROS 09 ) <br />AND ❑ Is located in this folder <br />❑1 Is in a Separate Green Folder coin with this foldarfor permitissuance) <br />19 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 />Completed By: Date: . <br />` FC3 <br />