118 SE EVERETT MALL WAY 2022-03-23

Intake & Approval Sheet 10 (FOR PERMIT STAFF ONLr PERMIT # AAPd3 —005 BUILDING Intake OK by: Date: Intake Comments: e ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement []No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System []Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System []Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add'I RCW 64.55 docs required prior to final? []Yes ❑ No VALUATION, CALCULATION: Total $ ,Zp 4 ,!;,l0 .24 Additional Notes: Approved By: Date: fir t( 2,0 FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers ❑Fire Alarm ❑Other: .T Additional Notes: , Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE ❑ Review / Inspection Scope -ADD FIRE FEE Approved By: Date: ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: Intake Comments: ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other Departments ❑ Hold in Planning File Drawer Zone Overlay/Agreement Nonresidential Use . Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes Ao "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School Dist Additional Notes: Approved By: Date: ko. LA P LIC WORKS Intake OK by: Date: _.._.,.,,,... ............................ ..... ,W...w.............. -........ ......,................. .Y.......... ,... .......,.. Intake Comments: IPW Worksheet Needed if: ,DSys Dev Eval []Traffic Mit Eval []Site Work or Drainage Proposed . I]Backflow Prevention for high hazard: :(dental, medical, animals, mortuary, hospital, :supportive housing) e.,........,....._...,,.......,...,......... .... ...........................,......,........,....,..,..._._...,...-....,........�, ❑Route this folder for PW Review at end --- PW Review Worksheet ❑This project also has a separate concurrent PW Review (Green Folder) AND [Create Green Folder ❑Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items ❑ A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is located in this folder ❑ Is in a Separate Green Folder (join with this folder for permit issuance) ❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: