Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING , <br /> Intake OK by: Date: Intake OK by: Assign To: -'CK Date: <br /> Intake Comments: Intake Comments: <br /> Zone <br /> ❑ Make this a"W"Permit ❑ SRC Required (Pre-Insp) Overlay/Agreement <br /> BldgM/Addn/Rem Size Nonresidential Use <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement ❑No ❑Yes, i /Unfin Total No.of Dwelling Units: <br /> Type of Construction flr Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Occupancy Group "(!,(, "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load r` <br /> p Y ! School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? Wo Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 ©2018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ❑New System ©Not Req'd Park Impact Fees for permits applied for after 1/112022: <br /> Reason Sprinklers Required: Park Impact Fee Total (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: 1Ve 2x�alls�or. o �e°x. Str✓c>+-vvYS <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes p No <br /> +2 DG o✓� fCS <br /> Add'I RCW 64.55 docs required prior to final? E]Yfi3 RNo Additional Notes: '� s <br /> VALUATION CALCULATION: Total$ I Tex fewd4A sof" (AWN 9`NZbSao l� - /q9�, SP <br /> Approved By: Date: !I v-1- <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheef Needed if.• <br /> ❑Sys Dev Eval: <br /> Additional Notes: ❑Water ❑Sewer ❑Storm <br /> ❑Traffic Mitigation Eva[ <br /> Approved By: L C Date: ( �, !❑Site Work/Drainage(shown/triggered) <br /> ❑Address Letter <br /> FIRE DEPARTMENT I❑Backflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: i(dental,medical,animals,mortuary, <br /> hospital,supportive housing) <br /> El Fire Sprinklers El Fire Alarm ❑Other: <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Qoin with this foiderfor permit issuance) <br /> Approved By: Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> i <br /> Public Works has no scope on this permit---PW Not Required <br /> ELECTRICAUPLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By—` c �-� Date: p 23 <br />