3405 ROCKEFELLER AVE A, B, C 2025-08-19

Intake &Approval Sheet -FOR PERMIT STAFF ONL?'� PERMIT# 6�-�0��0 03C— BUILDING PLANNING w_730(—7(( Intake OK by: Date: Intake OK by:�_ Assign To: Date: Intake Comments: Intake Comments: Zone V Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use ❑ Route to Residential Building Residential Use /I/lr ❑ Make this a"W" Permit Proposed No. of Dwelling Units: 3 (4 }nkt Bldg/TI/Ad Re ize Total No. of Dwelling Units: Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No Number of Stories I "In Lieu" Fee:Type: Amount$ Basement ❑No es , Fin/Unfin School Impact Fee: Total $ IJlA Type of Construction VJ5 Calculated: Credit: Occupancy Group r2Z ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 111/2022: Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fee Total$ IA Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: ❑Update Existing ❑New Syste of Req'd Permit Technicians:Apply Credit Per EMC19.53.200 Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/l/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? Myes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 Add1 RCW 64.55 docs required prior to final? ❑Yes ❑No ❑ 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ Z.7•S 000,oo Additional Notes: L SCgl Approved By: :" Date: 4 PUBLIC WORKS Additional Notes: TU fflQfVZ,0,'—' Intake OK by: fit Date: Z Z7i Intake Comments: 4cly 6yss ( ` � '� 1 ;PW Worksheet Needed if.• Flom `hd i 14 ,s I bt5 MSys Dev Eva] IATraffic Mit Eva] Approved B Date:pZ /7 ZOZ 3 ty�IrylpW Wt, �Stts 611' fi Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: ,, 1� (dental,medical,animals,mortuary,hospital, Nm FIRE DEPARTMENT • w —G✓AXkJ_'' ;supportive housing) Sce: A—&-I f414t., :----------------------------------------- Separate/Deferred Submittals Required: IgRoute 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 ❑Create Green Folder []Submitted Previously ❑Deferred ❑ This Permit is Ap roved by Public Works' ;�� p r r F �; Imnni Y\A&&tt)A Fire Dept. Fees: ee P Review Wo ks eet and associat d attached items A/ , ❑ 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 folderfor permit issuance) Approved By: V0 J,n Date: 1 1 — ❑WIII 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: (a/to �,�3