9930 EVERGREEN WAY THERAPEUTIC HEALTH SERVICES 2022-02-04

Intake & Approval Sheet (FOR PERMIT STAFF ONLY9 PERMIT # /J/go/ —vl 7 BUILDING Intake OK by Date: 07 I-7 / Intake Comments: ,eeVE,5ra" Td AeX,-A rT Ale 94/ -0/7 zoxx Tir- fe eV /," . ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W"Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement []No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System []Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing El New 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? ❑Yes El No VALUATION CALCULATION: Total $ Additional Notes: Approved 136,C Date:p� / 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 Additional Notes: Approved By: Date: PLANNING Intake OK by: Date: Assign To: Intake Comme�r\FileDrawer ❑ Attach to Pr ❑ Route to His ❑ OK to Routents ❑ Hold in Plan Zone Overlay/Agreement Nonresidential Use Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required befor final? ❑Yes []No "In Lieu" Fee: Type: Amount School Impact Fee: Total $ Calculated: Credit: []Everett School Dist ❑Mukilteo School Dist Additional Notes: Approved B \ yrj Date: 6% /9/Z,6/9 PUBLIC WORKS Intake OK by: Date: Intake Comments:\\(dental, ; PW Worksheet Needed if., ❑Sys Dev Eval []Traffic Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: medical, animals, mortuary, hospital, pportive housing) --------------------------------------- ❑Route this folder for PW Review at d PW Review Worksheet ❑This project also has a separate concu ent PW Review (Green Folder) AND ❑Create Green Folder ❑Submitte reviously [Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated a ached items ❑ A Separate PW Permit is Required (Permit #: P ) AND Ells located in this folder ❑ Is in a Separate Green Folder (join with this folder r permit issuance) ❑ WIII be Issued Separately (Separate Green Folder, PW' sued ahead of Bldg) ❑ Public Works has no scope--- PW Not Required Additional Notes: A Approved By Date: 07 /S i 9