3202 COLBY AVE PERFORMANCE HOME MEDICAL 2023-07-14

Intake $ Approval Sheet (FOR PERMIT STAFF ONLI) PERMIT# I ! BUILDING PLANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use rp ❑ Route to Residential Building Residential Use ❑ Make this a"W"Permit Proposed No.of Dwelling Units: Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No Number of Stories "In Lieu"Fee:Type: Amount$ Basement ❑No ❑Yes , Fin/Unfin School Impact Fee: Total $ Type of Construction Calculated: Credit: Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 1/112022: Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Park Impact Fee Total$ Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: ❑Update Existing ❑New System El Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/112022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 Add1 RCW 64.55 docs required prior to final? ❑Yes ❑No ❑ 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ f o°+?Do Additional Notes, r1way. kJvI 1,23 Approved By: Date: PUBLIC WORKS Additional Notes: Intake OK by: _Date: _ Intake Comments: PIN WorksheefNeeded if.• - []Sys Dev Eval ❑Traffic Mit Eva[ Approved Date lj /� ? {[]Site Work or Drainage Proposed Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, FIRE DEPARTMENT :supportive housing) Separate/Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet ❑Fire Sprinklers ❑Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works Fire Dept. Fees: ❑ See PW Review Worksheet and associated attached items ❑ Review of As-Built Plans-NO FIRE FEE ❑ A Separate PW Permit is Required(Permit#: PW ) ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is Ina Separate Green Folder Coin%vith this folder for permit Issuance) Approved By: Date: ❑Will be issued separately(separate Green Folder,PW issued ahead of Bldg) ❑ Public Works has no scope--- PW Not Required ELECTRICAL/PLUMBING Additional Notes: Additional Notes: Approved By: Date: JApprovocl By: Date: