11325 19TH AVE SE 2025-04-21 - Laserfiche WebLink

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (( - a GS BUILDING • 110LANNING 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? ❑Yes ❑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 ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 1/1/ 2: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fee Total$ (net due after redit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: ❑Update Existing ONew System ❑Not Req'd Permit Technician Use Only:Apply Phase-In 'redit Per EMC19.53. 0 Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/21 2 1 RCW 64.55 MF Worksheet req'd for permit? ❑Yes El No 0 50%Credit-Issued 9/3/2022-6/2/'023 J/ Add'I RCW 64.55 docs required prior to final? ❑Yes No ❑ 0%Credit-Issued 6/3/2023 or I.ter VALUATION CALCULATION: Total $ -tz 7JZ Additional Notes: Approved By: y ri Date: 11 61e 'Z PU C WORKS Additional Notes: Intake OK by:43)— Date: I\1n 41 2 z/ Intake Comments. PW Worksheet Needed if: ❑Sys Dev Eval(Util/SW) ❑Traffic Mit Eval Approved • Date:/ /4t�1't7 , ❑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 OFire Sprinklers ❑Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred 0 This Permit is Approved byPublic Works Pp Fire Dept. Fees: 0 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 0 Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) Approved By: re.)i-,rt Date:,i— ❑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: - /t4NwU I I . Q� Approved By: Date: Completed By: Date: