4201 RUCKER AVE COMMUNITY HEALTH CENTER 2022-10-07

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 1521I2.—OO$. BUILDING . • PLANNING' . " . • Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: O Route to Commercial Building 0 Attach to Project No. ❑ Route to Residential Building 0 Route to Historic Reviewer ❑ Make this a"W"Permit ❑ OK to Route to Other Departments BIc9ddn/Rem Size 7 160 ,I f 0 Hold in Planning File Drawer Garage/Accessory Struct.Size Who Zone Number of Stories 3 Overlay/Agreement Basement KNo ❑Yes, Fin/Unfin Nonresidential Use . Type of Construction • J ''.B Residential Use Occupancy Group a Proposed No.of Dwelling Units: Occupancy Load Total No.of Dwelling Units: Fire Sprinklers: PJpdate Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No Reason Sprinklers yRequired: "In Lieu"Fee:Type: Amount$ Fire Alarm: r ItUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Everett School Dist ❑Mukilteo School Dist Aden RCW 64.55 docs required prior to final? ❑Yes ,�No Additional Notes: c -e(✓- ncoae ram. I', (/ s�"VALUATION CALCULATION: Total$��0JDbO.Ob \) h dr— _n6m-Y- , o Approved By: )1„ Date: I.u,LZ PUBLIC WORKS: Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Needed if: 'DSys Dev Eval ❑Traffic Mit Eval �\ • IDSite Work or Drainage Proposed. Approved Bi,,s,1[ Date: /� // ,/ ;OSackflow Prevention for high hazard: """''"' j _(dental,medical,animals,mortuary,hospital, isupportive housing) FIRE DEPARTMENT ❑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) . .F+fe-Sprinklers Jre Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: 0 This Permit is Approved by Public Works ', RSee 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 0 Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ 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:\ ,13,rQ I w y n Date: 12'"7 / 0 Public Works has no scope--- PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By:4.�. P Date: p f/20[70 77 /`