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3726 BROADWAY GATEWAY SURGICAL CENTER 2020-01-21
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3726 BROADWAY GATEWAY SURGICAL CENTER 2020-01-21
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Last modified
1/21/2020 3:10:11 PM
Creation date
1/21/2020 3:09:42 PM
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Template:
Address Document
Street Name
BROADWAY
Street Number
3726
Tenant Name
GATEWAY SURGICAL CENTER
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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# /5' /9 41 C- <br /> BUILDING PLANNING; <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> El Route to Commercial Building 0 Attach to Project No. <br /> 0 Route to Residential Building 0 Route to Historic Reviewer <br /> Make this a"W'Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ONo DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: OUpdate Existing ONew System QNot Req'd Planning/Landscape Inspection Required before Final? DYes ONo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: OUpdate Existing'New System Mot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 0 No Everett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ©No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: <br /> PUBLIC WORKS. <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Wolf/sheetNeededlF 111111 11 1 <br /> ED.Sys Dev Eval OTraffic Mit Eval <br /> ('( ;Site Work or Drainage Proposed <br /> Approved By: Date: Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> (supportive housing) <br /> FIRE DEPARTMENT ,'" ; 0Route this folder for PW Review at end --- PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) This project also has a separate concurrent PW Review (Green Folder) <br /> Route to Fire Drawer---Fire Preliminary Review Notice AND OCreate Green Folder 0Submitted Previously ElDeferred <br /> OSending Fire Notes to Project Team taThis Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ElUpdate Existing ONew System El Not Req'd 0 A Separate PW Permit is Required(Permit#: PW <br /> Fire Alarm: OUpdate Existing ONew System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: OUpdate Existing ONew System 0 Not Req'd 00.Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> Additional Notes: App rbe Ff-f Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: -'�'/1"-- Date: ?//77/q 13 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> 'ELECTRICAL`. , <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />
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