1920 MONROE AVE 2025-04-16 - Laserfiche WebLink

Intake &Approval Sheet •(FOR PERMIT STAFF ONLY • PERMIT# 3 ZZ 1 ( -/ I , nnBUILDING , t PLANNING -�Intake OK by: R�( Date: Intake OK by: Assign To:jeS S i CC,& Date: I‘)17/ZZ Intake Comments: t Intake Comme t�sZyr-) plvmbrny/mect-Icon al/elec�rtccA t� Aass ice+. Zone Overlay/Agreement 111/F4 ❑ Route to Commercial Building Nonresidential Use N/A IFRRoute to Residential Building Residential Use S F iZ ❑ Make this a"W"Permit Proposed No. of Dwelling Units: Ill/A ''�1 I/Add em 7'7© 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 Flo ❑Yes , Fin/Unfin S hool Impact Fee: Total $ Type of Construction $�-(. Calcula • Credit: Occupancy Group Tj2-e DEverett Sch Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees fo ermits applied for afte /2022: Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fee Total$ ue after credit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calcula' ea : Fire Alarm: ❑Update Existing ❑New System ENot Req'd Permit Technician U nly:Apply Phase-In C ' Per EMC19.53.200 Reason Fire Alarm Required: ❑ 100% edit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes No 0 0%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yes g\lo 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ 50j0 Additional Notes:v1O add i+:oa1 aA vnt+s +•-:c3ger:<1q 'es- Approved By:/`` Date: II/17/ZZ- f PUBLIC WORKS Additional Notes: Intake OK by: Date: Intake Comments: PW Worksheet Needed if: ❑Sys Dev Eval(Util/Sw) ❑Traffic Mit Eval Approved By: e }Q Date: tA/V;r/ zin4c ❑Site Work/Drainage ❑Address Letter ❑Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT supportive housing) Separate/Deferred Submittals Required: DRoute 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: Completed By: Date: