10121 EVERGREEN WAY BASE FILE 2025-08-05

�' �"V1SiGY1 A�FtY I�SI��° Intake & Approval Sheet (FOR PERMIT STAFF ONLI9 PERMIT #y%'O1q BUILDING Intake OK by: Data: Intake Comments: ❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) Bldg/fl/Addn/Rem Size l$ r Garage/Accessory Struct. Size Number of Stories Basement ITNo []Yes, Fin / Unfln Type of Construction Occupancy Group Occupancy Load IR Cert. of Occpuancy Required? PgNo ❑Yes []Shell Only Code Year 112021 Q2018. 112015 Fire Sprinklers: ❑Update Existing []New System QNot Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System ®Not Req'd Reason Fire Alarm Required: ROW 64.55 MF worksheet req'd for permit? []Yes No Addl RCW 64.55 docs required priorto final? ❑Yes ®No VALUATION CALCULATION: Total$ Ll DC Additional Notes: Approved By: Date: % -1241 FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑ Fire Sprinklers ❑FlreAlarm ❑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: ELECTRIQAL'IPLU MBING Additional Notes: Approved By: Date; PLANNING Intake OK by: Assign To: Date: Intake Comments: Zone Overlay/Agreement Nonresidential Use Residential Use Proposed No, of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? []Yes ❑No "in Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: []Everett School Dist ❑Mukilteo School Dist Park Impact Fees for permits applied for after 11112022: Park Impact Fee Total $ (net due after credit for existing uses) Fee Schedule Used For Calculation (Year): Additional Notes: Approved Byc Date: PUBLIC WORKS Intake OK by: Date: PWRevtew& Worksheet Needed If., Intake Comments: ❑Sys Dev Eval : ❑Water ❑Sewer ❑Storm ❑Traffic Mitigation Eval ❑Site Work/Drainage (shownitriggered) ❑Address Letter ❑Backgow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, supportive housing) ❑ 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 fully digital , ❑ Is located In this folder ❑ Is In a Separate Green Folder Coin with this folder for pennit Issuance) ❑ WIII be issued separately (Separate Green Folder, PW Issued ahead of Bldg) ❑ Public Works has no scope on this permit--- PW Not Required Additional Notes: Completed By: Date: