10110 19TH AVE SE 2023-06-23 - Laserfiche WebLink

Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) PERMIT# 822l Z— a 6 Z BUILDING WLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone m_t) Overlay/Agreement _ ❑ Route to Commercial Building Nonresidential Use ❑ Route to Residential Building Residential Use .fl ) 1414frtil ❑ Make this a"W"Permit Proposed No. of Dwelling Units: Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No Number of Stories "In Lieu"Fee: Type: Amount$ - Basement ❑No ❑Yes , Fin/Unfin School Impact Fee: Total $ Type of Construction Calculated: Credit: Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fee Total$ (net due after credit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 - Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ 9 OG(2,00 Additional Notes: Approved By: Date: • PUBLIC WORKS Additional Notes: Intake OK by: Date: Intake Comments: PW Worksheet Needed if: ❑Sys Dev Eval(Util/SIN)OTraffic Mit Eval Approved By gk j Date:j�/ / ❑Site Work/Drainage ❑Address Letter ❑Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT supportive housing) Separate/Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet ❑Fire Sprinklers ❑Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND OCreate Green Folder OSubmitted Previously ❑Deferred ❑This Permit is Approved by Public Works Fire Dept.Fees: ❑ See PW Review Worksheet and associated attached items ❑ Review of As-Built Plans-NO FIRE FEE 0 A Separate PW Permit is Required(Permit#:PW____________) ❑ Minimal or No Fire Scope-NO FIRE FEE AND 0 Is located in this folder Review/Inspection Scope-ADD FIRE FEE El Is in a Separate Green Folder(join with this folder for permit issuance) Approved By:KR)t-oky Yl Date:gl-a24/7,2.3 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) 41JPublic Works has no scope---PW Not Required ELECTRICAL/PLUMBING Additional Notes: - Additional Notes: Approved By: Date: Completed By: Date: l vi'M([7,0 ziV 4