2722 COLBY AVE COMMUNITY HEALTH CENTER 2023-08-02

Intake & Approval Sheet *FOR PERMIT STAFF ONLY) • PERMIT # &Xrloe' 094f BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building _ ❑ Make this a "W" Permit , Bldg/T / dd em Size Garage/Accessory Struct. Size Number of Stories Basement No ❑Yes , Fin / Unfin Type of Construction Occupancy Group C3 Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System P&ot Req'd Reason Sprinklers Required: Fire Alarm: igUpdate Existing ❑ New System- Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes No Add'] RCW 64.55 docs required prior to final? ❑Yes Vo VALUATION CALCULATION: Total $ �OOL:1,00 s Additional Notes: Approved B • Date: p 7,1% FIRE DEPARTMENT Separate I Deferred Submittals Required: ❑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: Assign To: Date: Intake Comments: M I 1 ❑ 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 No "In Lieu" Fee: Type: mount $ School Impact Fee: Total $ Calculated: redit: ❑Everett School Dist ❑M Iteo School Dist Additional Notes: Approved By: Date: UBLIC WORKS Intake OK by: --r" Date: Intake Comments: 'PW Worksheet Needed if., d', `Y !OSys Dev Eval ❑Traffic'Mit Eval (_]Site Work or Drainage Proposed 013ackflow Prevention for high hazard: ,(dental, medical, animals, mortuary, hospital, 'supportive housing) :.,..,..........,............... ........ . ..... _... ......... ........ ....... _........................... ❑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 3 ❑ 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) E)�ublic Works has no scope --- PW Not Required Additional Notes: t 9(2� u Approved By: Date: s�_