620 112TH ST SE SPACE 191 2023-08-03

Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# 1 j'23 0 Z — 1 0 BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone 1 l� Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use ❑ Route to Residential Building Residential Use i+ j(A - ❑ 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 .-•c— 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: El Update Existing El New System IPdot Req'd Park Impact Fee Total$ Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: El Update Existing El New System grNot Req'd Permit Technicians:Apply Credit Per EMC19.53.200 Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes rt No ID 50%Credit-Issued 9/3/2022-6/2/2023 Add!RCW 64.55 dots required prior to final? ❑Yes No ❑ 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$1-P Additional Notes: ce-DAY\0_1(, --1(10 2-/27[7.--3 Approved By: Date: PUBLIC WORKS Additional Notes: 1705r g-EQLA lEAr Intake OK by: Date: -w 01301, �L ' ©� Intake Comments: PW Worksheet Needed if: 4-04-9 I DSys Dev Eval ©Traffic Mit Eval Approved By: p H Date: 4217 I 11`L: I DSite Work or Drainage Proposed I DBackflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT Isupportive housing) Separate I 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 ❑Create Green Folder ❑Submitted 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 ❑ A Separate PW Permit is Required (Permit#: PW ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) Approved By: Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) ❑ Public Works has no scope--- PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: Approved By: Date: