620 112TH ST SE SPACE 193 2023-08-01

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) 4pCANNING PERMIT# 3i-3o L- 0 13 BUILDING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone r5 3 Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use ❑ Route to Residential Building Residential Use ❑ 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 I "In Lieu" Fee: Type: Amount$ Basement ElNo ❑Yes , Fin/Unfin School Impact Fee: Total $ Type of Construction 1-QJt' Calculated: Credit: Occupancy Group TILL DEverett School Dist ❑Mukilteo School Dist Occupancy Load L 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 ONew System giNot 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 la No 0 50%Credit-Issued 9/3/2022-6/2/2023 Add!RCW 64.55 does required prior to final? ❑ rrYes I to 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ 201O0C Additional Notes: are 1 ►�a P 7/23 Approved pp By:y. Date: • PUBLIC WORKS Additional Notes: Intake OK by: Date: Intake Comments: PW Worksheet Needed if: OSys Dev Eval(Util/SW)❑Traffic Mit Eval Approved By: Date: Livi tp 23 ❑Site Work/Drainage ❑Address Letter ❑Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT supportive housing) Separate I Deferred Submittals Required: DRoute this folder for PW Review at end ---PW Review Worksheet El Fire Sprinklers DFire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) Additional Notes: ND ❑Create Green Folder ❑Submitted Previously ❑Deferred This Permit is Approved by Public Works Fire Dept. Fees: KSee 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 0 Is located in this folder ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) ��J 0Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By:��` �� Date: ❑ Public Works has no scope---PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: Completed By: Date:4 i 4(17&r5--- jput4414k o 61161243 23