9930 EVERGREEN WAY THERAPEUTIC HEALTH SERVICES 2022-02-04

Intake & Approval Sheet (FOR PERMIT STAFF ONLr . PERMIT #� 10 v 1 -v �J BUILDING Intake OK by: Date: ll/ q Intake Comments ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size (0 Garage/Accessory Struct. Size -- Number of Stories Basement 12'No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load 28 Fire Sprinklers: ❑Update Existing El New System R3 Not Req'd Reason Sprinklers Required: Fire Alarm: Update Existing ❑New System ff Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes 5rNo Add'I RCW 64.55 docs required prior to final? ❑Yes P No VALUATION CALCULATION: Total $ 4 00 , 000 Additional Notes: Approved By: Date: Ell'F, q Al '77FIRE DEPARTMENT Intake: (Needed for Townhomes, Alley load SFR, New Commercial) ❑ Route to Fire Drawer --- Fire Preliminary Review Notice ❑Sending Fire Notes to Project Team Date: (OK to Route to Other Departments) Fire Sprinklers: El Update Existing ❑New System ❑ Not Req'd Fire Alarm: ❑Update Existing ❑New System ❑ Not Req'd Chemical Sup: ❑Update Existing El New System ❑ Not Req'd Additional Notes: P611It �- Approved By: ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: Date: Intake Comments: Assign To: ❑ Attach to Project No. ❑ Route to Historic Reviewer ❑ OK to Route to Other Departments ❑ Hold in Planning File Drawer Zone Overlay/Agreement Nonresidential Use Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes ❑No "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School Dist Additional Notes: Approve Date: ( i PUBLIC WORKS Intake OK by: + Date: I lit I G -- ------ I ---- -------------------------- Intake Comments: ;PW Worksheet Needed if.• ❑Sys Dev Eval ❑Traffic Mit Eva[ q'vv y.1 G, -gEr , � >zJo ►.� ; ❑Site Work or Drainage Proposed < ❑Backflow Prevention for high hazard: 0 Zw Cap ti :(dental, medical, animals, mortuary, hospital, ,6 Y S D 9td , 6 f— S ;supportive housing) ❑Route this folder for PW Review at end --- PW Review Worksheet ❑This project also has a separate concurrent PW Review (Green Folder) AND ❑Create Green Folder ❑Submitted Previously []Deferred ❑ 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 located in this folder ❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) ❑ Will be Issued separately (separate Green Folder, PW issued ahead of Bldg) blic Works has no scope --- PW Not Required Additional Notes: Approved By: Date: