916 PACIFIC AVE 2ND FLOOR 2025-06-30

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # S 2 i C) BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement []No []Yes, Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System ❑ Not Req'd Reason Sprinklers Required: Fire Alarm: []Update Existing [I New System []Not Req'd Reason Fire Alarm Required: . RCW 64.55 MF worksheet req'd for permit? Dyes ❑ No Add'I RCW 64.55 docs required prior to final? ❑Yes ❑ No VALUATION CALCULATION: Total $ ,Lo, Additional Notes: Approved By Date: ZI dr o FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers ❑Fire Alarm []Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE ❑ Review / Inspection Scope - ADD FIRE FEE Approved By: Date: ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: Date: Intake Comments: ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other Departments / ❑ Hold in Planning File Drawer Zone Overlay/Agreement Nonresidential Use . Residential Use Proposed No. of Dwelling U its: Total No. of Dwelling Unit /. Planning/Landscape I pection Required before Final? ❑Yes []No "In Lieu" Fee: Type: I Amount $ School Impact Fee: Total $ Calculated. Credit: ❑Everett Schoo ist ❑Mukilteo School Dist Additional Note . Approved Date: PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Worksheet Needed if: ❑Sys Dev Eval []Traffic Mit Eval 1 ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, supportive housing) ❑Route this folder for PW Review at end --- PW Review Worksheet ❑This project also has a separate concurrent PW Review (Green Folder) AND []Create Green Folder [Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items ❑ A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is located in this folder ❑ Is in a Separate Green Folder ((oin with this folder for permit Issuance) ❑ Will be issued separately (separate Green Folder, PW Issued ahead of Bldg) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: