10 SE EVERETT MALL WAY BASE FILE 2025-04-14

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# I 12201 b I(a BUILDING PLANNING • Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: • ❑ Route to Commercial Building ❑Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit ❑ OK to Route to Other Departments Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer Garage/Accessory Struct.Size_ Zone Number of Stories Overlay/Agreement Basement El No ❑Yes, Fin/Unfin Nonresidential Use 1VZ t Jk,1 Type of Construction Residential Use _ Occupancy Group Proposed No.of Dwelling Units: Occupancy Load Total No.of Dwelling Units: Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required befor nal? ❑Yes ❑No Reason Sprinklers Required: "In Lieu"Fee:Type: mount$ Fire Alarm: El Update Existing El New System El Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dis ❑Mukilteo School Dist Add]RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: VALUATION CALCULATION: Total$ Approve y: C Date: \ PUBLIC WORKS Intake OK by: . Date: Additional Notes: Intake Comments: PWWorksheet Needed if: ° Sys Dev Eval ❑Traffic Mit Eval �y� OSite Work or Drainage Proposed Approved By: 3� Date: /,//�/)z2 OBackflow Prevention for high hazard: `(dental,medical,animals,mortuary,hospital, _supportive housing) • FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder OSubmitted Previously ❑Deferred Additional Notes: ❑This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items Fire Dept. Fees: • ❑A Separate PW Permit is Required(Permit#:PW ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: ❑ Public Works has no scope---PW Not Required _ Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: