3726 BROADWAY MOUNTAIN PACIFIC BANK 2025-04-11

Intake &Approval Sheet .(FOR PERMIT STAFF ONLY) PERMIT# �1 —30 L- 0 4- BUILDING lik.AINNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: ZonerviU Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use _ 4 r ❑ Route to Residential Building Residential Use ❑ Make this a"W"Permit Proposed No. of Dwelling Units: Bldg/TI/Addn/Rem Size Z�/63 $"f Total No.of Dwelling Units: Garage/Accessory Struct.Size /t/%d Planning/Landscape Inspection Required before Final? ❑Yes ❑No Number of Stories 3 "In Lieu"Fee: Type: Amount$ Basement ENo ❑Yes , Fin/Unfin School Impact Fee: Total $ Type of Construction V.3 Calculated: Credit: Occupancy Group .5 ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load `e-1-- Park Impact Fees for permits applied for after 1/1/2022: Fire Sprinklers: aUpdate Existing ❑New System ❑Not Req'd Park Impact Fee Total$ (net due after credit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: Update Existing ['New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes 123 No 0 50%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yes EtNo 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ / Dao.OJ Additional Notes: Approved By: Date: • PUBLIC WORKS Additional Notes: Intake OK by: Date: Intake Comments: PW Worksheet Needed if: OSys Dev Eval(Util/SW)OTraffic Mit Eval Approved By Date: 6qg70Z3 OSite Work/Drainage DAddress Letter DBackflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT supportive housing) FaSe rate/Deferred Submittals Required: El Route this folder for PW Review at end ---PW Review Worksheet ire 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 ►2-Review/Inspection Scope-ADD FIRE FEE ElIs in a Separate Green Folder Gain with this folder for permit issuance) Approved By: RJ-cc ,t)v( Date: %S^ (j- 3 CI 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: