2118 VIRGINIA AVE 2025-10-24 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLI) J -e ' S 1 UYIS A tl ► SSto PERMIT # V 2-009 —0 Z.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: El Update Existing ❑New System ❑Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System []Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Addl RCW 64.55 docs required prior to final? ❑Yes []No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: 4 FIRE DEPARTMENT Separate / Deferred Submittals Required: []Fire Sprinklers []FireAlarm []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: ELECTRICAL/PLUMBING Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: Intake Comments: Zone , 2 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 Sc ooI Dist Park Impact Fees for permits applied rafter Ill/2022: Park Impact Fee Total $ (et due after credit for existing uses) Fee Schedule Used For Calculation (Year Permit Technician Use Only: Apply P ase-In Credit Per EMC19.53.200 ❑ 100% Credit - Issued 1/1 /2022 - /2/2022 ❑ 50% Credit - Issued 9/3/2022 6/2/2023 ❑ 0% Credit - Issued 6/3/202 or later Additional Notes: &j.�xn&W' IAc(,Oi\,. -a kN- -.. C-so mi- log Approved By. Date: UBLIC WORKS_ Intake OK by: Date: :.�,_...-,_..._............... ...... ...... ....-_._ ..._ , ..........-...._.., Intake Comments: =PW Worksheet Needed if.• []Sys Dev Eval (Util/SW) ❑Traffic Mit Eval =OSite Work/Drainage ❑Address Letter `13Backflow 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 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: Completed By: Date: