1010 SE EVERETT MALL WAY NORTHWEST KIDNEY CENTER - EVERETT 2022-03-07

Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLIO 0 PERMIT #M ZED L" 02-1?_-�, BUILDING Intake OK b Date: l6 Intake Comments: Route to ,� PIZ6W ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg[TUAddn/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 ❑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 ❑No VALUATION CALCULATION: Total ,$ Additional Notes: Approved By: '�7 Date: ,1 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:A/ Assign To: � Date: U lzoal Intake Comments: ❑ 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 "In Lieu" Fee: Type: Amount $ School Impact Fee: Total $ Calculated: Credit: El Everett School Dist ❑Mukilteo School Dist Additional Notes: Approved By: Date: Fi PUBLIC WORKS Intake OK by: Date: ....................................,......,.,.................,..,.......,..,.....,,..,................,,.,,,,..,..................................... Intake Comments: PW Worksheet Needed if., (]Sys Dev Eval ❑Traffic Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: .(dental, medical, animals, mortuary, hospital, ,supportive housing) e._....... .................. ................................_....................... ............ _.................... .................. []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 (join with this folder for permit issuance) ❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) ❑ Public Works has no scope --- PW Not Required Additional Notes: Approved By: Date: 7.