8609 EVERGREEN WAY COMMUNITY HEALTH CENTER 2022-10-14

Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# -(a^bO BUILDING - PLANNING* . - • - - Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: ❑ Route to Commercial Building ❑Attach to Project No. ❑ Route to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit 0 OK to Route to Other Departments BI !T//ddn/Rem Size j000 fi ❑ Hold in Planning File Drawer Garage/Accessory Struct.Size /✓0 Zone ti10 Number of Stories Overlay/Agreement Basement K1No ❑Yes, Fin/Unfin Nonresidential Use Type of Construction - Residential Use Occupancy Group Proposed No.of Dwelling Units: Occupancy Load • • Total No.of Dwelling Units: Fire Sprinklers: Update Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes INo Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ Fire Alarm: ,Update Existing El New System ❑Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑ AEI, No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes J1No Additional Notes: \ A LOONv Call ,,� VALUATION CALCULATION: Total$ya°000,00 uo 0r 6 ky,ev ,,Q,, RA 0-0 Approved By: y,, Date: 1-L„j , PUBLIC VVOR}CS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if: 1DSys Dev Eval DTraffic'Mit Eval • • =DSite Work or Drainage Proposed Approved B ' Date f / 9Backflow Prevention far high hazard: // _(dental,medical,animals,mortuary,hospital, ;supportive housing) FIRE DEPARTMENT El Route 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 tikire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: ; ❑This Permit is Approved by Public Works - ❑See PW Review Worksheet and associated attached items Fire Dept. Fees: ❑A Separate PW Permit is Required(Permit#: PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder Coln with this folder for permit issuance) re-Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: 1"0W,(\ Date: )2—7-21 ❑ Public Works has no scope---PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: