8102 EVERGREEN WAY EVERETT 4 CORNERS - BLDG D 2025-08-06

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ri}Z 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 DNo Number of Stories "In Lieu" Fee: Type: Amount$ Basement ONo DYes , Fin/Unfin School Impact Fee: Total $ Type of Construction Calculated: Credit: Occupancy Group ❑Everett 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: DUpdate Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 Reason Fire Alarm Required: 0 100%Credit Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yes El No ❑ 0%Credit Issued 6/3/2023 or later VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: PUBLIC WORKS Additional Notes: Intake OK by: Date: Intake Comments: PW Worksheet Needed if: Sys Dev Eval (Util/SW) DTraffic Mit Eval Approved By: Date: ❑Site Work/Drainage DAddress Letter ElBackflow 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 Fire Sprinklers ❑Fire Alarm DOther: ❑This project also has a separate concurrent PW Review(Green Folder) 4Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works Fire Dept. Fees: 0 See PW Review Worksheet and associated attached items 0 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 0 Is located in this folder Review/Inspection Scope-ADD FIRE FEE ElIs in a Separate Green Folder(loin with this folder for permit issuance) Approved By:k.kli—f71.�� Date: ! - G�'; � El Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) 0 Public Works has no scope--- PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: Completed By: Date: