9628 19TH AVE SE G 2025-10-27 - Laserfiche WebLink

Intake & Approval Sheet 'FOR PERMIT STAFF ON09 , PERMIT # IJZ363`a7$ BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit &/TI/Addn/Rem Size 15?! j 5 e/AccessoryStruct. Size �r 5F Number of Stories Basement EINo ❑Yes , Fin / Unfin Type of Construction _3i Occupancy Group 11-C Occupancy Load J �L Fire Sprinklers: []Update Existing EgNew System El Not Req'd Reason Sprinklers Required: Fire Alarm: []Update Existing ❑New System &Not Req'd Reason Fire Alarm Required: r� RCW 64.55 MF worksheet req'd for permit? []YesEf No Add'[ RCW 64.55 docs required prior to final? []Yes ESNO LIVING —1573 SF @ $166/5F=$261,118 --1_ GARAGE — 561 SF @ $66/SF = $37,026 TOTAL VALUATION = $298,144 ADDITIONAL NOTES: SPECIAL INSPECTIONS REQ i Approved By: Date: 5 `15 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 E Review / Inspection Scope - ADD FIRE FEE Approved By: � Date: ELECTRICAL/PLUMBING Additional Notes: Approved By: Date: PLANNING 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: ,��3% Credit: � [gEverett School Dist ❑Mukilteo School Dist Park Impact Fees for permits applied for after 1/112022: Park Impact Fee Total $ 3/ SO Fee Schedule Used For Calculation (Year): �OZ� Permit Technicians: Apply Credit Per EMC19.53.200 ❑ 1.00% 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: By: Date: �EE PUBLIC WORKS Intake OK by: Date: ® Intake Commen PW Worksheet Needed if: __- 1ASys Dev Eval ®Traffic Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, supportive housing) I ❑ 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 5OSee 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 Qoin with this folder for permit Issuance) ❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: