900 PACIFIC AVE BASE FILE 2025-08-14

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# e72105^ Olb BUILDING PLANNING / Intake OK by: Date: Intake OK by: Assign To: JP SS Date: (D 5I Z-� Intake Comments: Intake Comment Zone (]Rt.{ M;xea ElMake this a "W" Permit ❑ its:d¢n+.4\ SRC Required (Pre-Insp) Overlay/Agreement MekroI use (me r odor• Bld /TI/Addn g Size C1 Nonresidential Use ( �'�r',c. Garage/Accessory Struct. Size Residential Use Number of Stories Proposed No. of Dwelling Units: Basement ❑No ❑Yes , Fin/Unfin Total No. of Dwelling Units: Type of Construction 1,4 Planning/Landscape Inspection Required before Final? ❑Yes No Occupancy Group "In Lieu" Fee: Type: Amount$Q Occupancy Load 3 School Impact Fee: Total $ Cert. of Occpuancy Required? tNo ❑Yes OShell Only Calculated: Credit: Code Year ?021 02018 02015 ❑Everett School Dist ❑Mukilteo School Dist Fire Sprinklers: itpdate Existing El New System Not Req'd Park Impact Fees for permits applied for after 1/1/2022: Reason Sprinklers Required: Vt- '`) LA4'"`1 Park Impact Fee Total$ Q (net due after credit for existing uses) Fire Alarm: 14Update Existing ❑New System ❑Not Req'd Fee Schedule Used For Calculation(Year): Reason Fire Alarm Required: V V ) ( W,i'(;v1 71 RCW 64.55 MF worksheet req'd for permit? ❑Yes Di No Add'I RCW 64.55 docs required prior to final? ❑Yes 17INo Additional Notes: VALUATION CALCULATION: Total $ l 67 r f l%li l Approved By: A1 2,- c,' Date:(0/5/Z1-1 PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Review&Worksheet Needed if: ❑Sys Dev Eval : ❑Water ❑Sewer ❑Storm Additional Notes: ( ❑Traffic Mitigation Eval Approved By: \/ Date: 1,, ( ((/7 kf ❑Site Work/Drainage(shown/triggered) I❑Address Letter FIRE DEPARTMENT I DBackflow Prevention for high hazard: ;(dental,me Separate/Deferred Submittals Required: t animals,supportive mortuary, 'hospital, housing) Eire Sprinklers ElFire Alarm ❑Other: 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 fully digital ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ 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:\ le) Date: 6.."/�/L ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Public Works has no scope on this permit--- PW Not Required ELECTRICAL/PLUMBING dditional Notes: Additional Notes: _ / Approved By: Date: Completed Br r9A/ Date: Qjio/ '26 2� I