500 SE EVERETT MALL WAY LES PHO 2023-07-28

Intake & Approval Sheet AM, (FOR PERMIT STAFF ONLr � PERMIT # - "Cl /—&D BUILDING Intake OK by: Date: Intake Comments: ❑ 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 El New System ❑Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing El New System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF vorksheet req'd for permit? ❑Yes ❑ No Add] RCW 64.55 docs required prior to final? ❑Yes ❑ No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: it aeg FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers ❑Fire Alarm ❑Other: 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: ELI=CTRICAL/PLUMBING Additional Notes: Approved By: Date: CANNING —2a Intake OK by: Assign To: Date: Intake Comments: Zone Overlay/Agreement Nonresidential Use Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes ❑No "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School Dist Park Impact Fees for permits applied for after 1/112022: Park Impact Fee Total $ (net due after credit for existing uses) Fee Schedule Used For Calculation (Year): -------------------------------------------------------------------------------- Permit Technician Use Only: Apply Phase -In Credit Per EMC19.53.200 ❑ 100% Credit- Issued 1/1/2022 - 9/2/2022 ❑ 50% Credit - Issued 9/3/2022 - 6/2/2023 ❑ 0% Credit - Issued 6/3/2023 or later Additional Notes: Approved By: Date: PUBLIC WORKS Intake OK by: Date: •----------------------------------------- Intake Comments: IPW Worksheet Needed if., El Sys Dev Eval (util/SW) ❑Traffic Mit Eva[ : ❑Site Work/Drainage ❑Address Letter ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, :supportive housing) '----------------------------------------- ❑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 Coin 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: Completed By. Date: 11 2pj ZZ 42,