9506 19TH AVE SE A T AND T ANTENNA 2025-04-21

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 772303--age BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use ❑ Route to Residential Building Residential Use ❑ Make this a"W"Permit Proposed No.of Dwelling Units: Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? DYes ❑No Number of Stories "In Lieu" Fee:Type: Amount$ Basement No ❑Yes, Fin/Unfin School Impact Fee: Total $ Type of Construction Calculated: _ Credit: Occupancy Group DEverett School Dist DMukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: Fire Sprinklers: ❑Update 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 DNot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? DYes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? DYes ❑No D 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ Jac?t, Additional Notes: Approved By: Date: ell(/l2.0l-S PUBLIC WORKS Additional Notes: Intake OK by: Date: Intake Comments: 1PW Worksheet Needed if: ❑Sys Dev Eval(utii/sw)❑Traffic Mit Eval Approved BL /� Date:O Z yrez3 =❑Site Work/Drainage ❑Address Letter ❑Backflow Prevention for high hazard: i(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: OThis project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND DCreate Green Folder ❑Submitted Previously DDeferred ❑ 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: