5130 EVERGREEN WAY COMMUNITY MEDICAL SERVICES 2025-05-09

/AALc1\CS 1.3c"App.(dt vcIA w.71AGGL to derv, IA...A NMI A 67 I,Hf r- um-71 VLKIVl11 F AI 1 O9' — y�/^G BUILDING " ANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone 1 1 Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use r CQO ce' ❑ Route to Residential Building Residential Use ❑ Make this a"W"Permit Proposed No.of Dwelling Units: Bldg/TllAddn/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 El Everett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 11'112022: Fire Sprinklers: ❑Update Existing ONew System ❑Not Req'd Park Impact Fee Total$ / (net due after credit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 Reason Fire Alarm Required: t—( El 100%Credit-Issued 1/1/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 Add'1 ROW 64.55 dots required prior to final? ❑Yes ❑No ❑ 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$ Additional Notes: 9-1Thic41 9- (-f i S/ 3 Approved By: Date: • PUBLIC WORKS . Additional Notes: Intake OK by: Date: Intake Comments: PW Worksheet Needed if Days Dev Eval(Util/SW) )]Traffic Mit Eval Approved By: Date: 4( � ❑Site Work/Drainage DAddress Letter ❑Backflow Prevention for high hazard: (dental,medical,animals,mortuary,hospital, •FIRE DEPARTMENT supportive housing) Separate 1 Deferred Submittals Required: DRoute 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: 0 See PW Review Worksheet and associated attached items ❑ Review of As-Built Plans-NO FIRE FEE 0 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 in a Separate Green Folder(join with 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/1?•.LUIVI.BING Additional Notes: Additional Notes: Approved By: Date: Completed By: Date: