1313 75TH ST SW BLDG A 2026-05-06

Intake & Approval Sheet (FOR PERMIT STAFF ONL)lPERMIT # I"' L .6 3 111 BUILDING Intake OK by: Date: Intake Comments: ❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) Bldg/TI/A n/Rem Size Garag Accessory Struct. Size Num er of Stories Ba ment ❑No ❑Yes , Fin / Unfin Type o onstruct[on Occupancy Group Occupancy Load Cert. of Occpuancy Requir d? ❑No ❑Yes ❑Shell Only Code Year 102021 112018. 112015 Fire Sprinklers: ❑Updat Existing ❑New System El Not Req'd Reason Sprinklers Requi ed: Fire Alarm: ❑Update ew System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? Yes ❑ No Add'I RCW 64.55 docs required prior to final? ❑ es ❑No VALUATION CALCULATION: Total $ Additional Notes: MA, Approved By: Date: V_ G / FIRE DEPARTMENT Separate / Deferred Submittals Required: El 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/PLUMBING Additional Notes: Approved By: Date: PLANNING Intake OK by: Assign To: "P(c4 Date: Intake Comments: S S Zone Overlay/Agreement 6.) kxww 1 Q.uw bit Nonresidential Use Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: (7 Planning/Landscape Inspection Required before Final? ❑Yes ONo "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School Dist Park Impact Fees for permit applied for after 1/1/2022: Park Impact Fee Total I (net due after credit for existing uses) Fee Schedule Used For Calculation (Year): Additional Notes: Approved By: - 7- Date: S Zdj/O PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Review S Worksheet Needed if.• El Sys Dev Eval : ❑Water ❑Sewer []Storm ❑Traffic Mitigation Eva[ ❑Site Work/Drainage (shovm/triggered) ❑Address Letter ❑Backflow 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 Qoln with this folderfor permit issuance) ❑ Will 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: