2204 12TH ST 2025-09-30 - Laserfiche WebLink

Intake & Approval Sheet FOR PERMIT STAFF ONLY) PERMIT# F A I36 �- - S BUILDING TANNING 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 I 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 11112022: 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: El Update Existing ❑New System ❑Not Req'd Permit Technician- Use Only:Apply Phase-In Credit Per EMC19.53,200----------- Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/212023 Add']RCW 64.55 does required prior to final? ❑Yes ❑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: ;PWWorksheet Needed if., ❑Sys Dev Eva[(011SW )]]Traffic Mit Eva] Approved By: Date: :❑Site Work/Drainage []Address Letter ❑Backfiow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT ;supportive housing) Separate I Deferred Submittals Required: ❑Route this folder for PW Review at end --PWReview worksheet - ❑Fire Sprinklers ❑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 Approved by Public Works Fire Dept. Fees: ❑ 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 ...Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder Coin with this folder forpermit issuance) Approved By: �� Date: El be issued separately(Separate Green Folder,PW issued ahead of Bldg) ❑ Public Works has no scope---PW Not Required ELECTRICALIPLUMBING Additional Notes: Additional Notes: Approved By: Date: lCompleted By: Date: