3726 BROADWAY GATEWAY SURGICAL CENTER 2020-01-21

Intake &Approval Sheet I (FOR PERMIT STAFF ONLY) PERMIT# I" L 5 7 OOS BUILDING PLANNING Intake OK by: Date: 4-I sI Intake OK by: Date: Intake Comment . Intake Comments: Assign To: INd C c e.fo kso'n uz2, flufozac ❑ Route to Commercial Building 0 Attach to Project No. ❑ Route to Residential Building 0 Route to Historic Reviewer O Ma e this a"W"Permit 0 OK to Route to Other Departments Bldg f ddn/Rem Size S'S /34f 0 Hold in Planning File Drawer Garage/Accessory Struct. Size i(//„Q Zone Number of Stories 3 Overlay/Agreement Basement EtNo ❑Yes, Fin/Unfin Nonresidential Use C\\NC. Type of Construction U I Residential Use Occupancy Group Proposed No. of Dwelling Units: Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: aJpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes I"No Reason Sprinklersrr ^Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: �rlylpdate Existing El New System El Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes No_ ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? oyes pNo Additional Notes: VALUATION CALCULATION: Total $/05 O .0 Approved Byr"----- Date: _05r.Z,CAQ PUBLIC WORKS Intake OK by::V4 Date: u1 / d tot 9 Additional Notes: Intake Comments: PW Worksheet Needed if: M n.l CFc.cZ.o ct -Try ❑Sys Dev Eval ❑Traffic Mit Eval ❑Site Work or Drainage Proposed Approved By: Date: o1/, y ❑Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, supportive housing) FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: 0 This Permit is Approved by Public Works 0 See PW Review Worksheet and associated attached items Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) .Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: %' «n Date: ?—?-/? lea Public Works has no scope---PW Not Required Addi ional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: