3726 BROADWAY MOUNTAIN PACIFIC BANK 2025-04-11

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Yfl O 4 061 BUILDING • PLANNING Intake OK by: Date: Intake OK by: g Assign To: %le.Ss Date:6/Z Ii z Intake Comments: Intake Comments: Zone �►U Overlay/Agreement lJ/A ❑ Route to Commercial Building Nonresidential Use 0 V.Ci,ce. ❑ Route to Residential Building Residential Use rN/A ❑ Make this a"W"Permit Proposed No.of Dwelling Units: N/ Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: WA Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes JNo Number of Stories "In Lieu"Fee:Type: Amount$ J Basement ❑No ❑Yes, Fin/Unfin School Impact Fee: Total $ 0 Type of Construction Calculated: Credit: Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: Fire Sprinklers: ❑Update Existing El New System Mot Req'd Park Impact Fee Total$ Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire,Alarm: El Update Existing ❑New System ❑Not Req'd Permit Technicians:Apply 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 ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No 0 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ Additional Notes: Approved By: Date:5/Z/2.3 PUBLIC WORKS Additional Notes: Intake OK by: Date: Intake Comments: IPW Worksheet Needed if: /.111 I❑Sys Dev Eval ©Traffic Mit Eval Approved By: c� Date: r t-r .'. I DSite Work or Drainage Proposed DBacicflow Prevention for high hazard: I(dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT :supportive housing) Separate!Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet El Fire Sprinklers El Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND El 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 coin 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: Approved By: Date: