10521 19TH AVE SE CASCADE RETINA OPTHALMOLOGY CLINIC 2024-11-07

on1►1e CLp Intake $ Approval Sheet (FOR PERMIT STAFF ONLr PERMIT #�E 13 W 032 BUILDING Intake OK by: Date: Intake Comments: ❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement ❑No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Cert. of Occpuancy Required? ❑No []Yes ❑Shell Only Code Year 102021 ❑2018 ❑2015 Fire Sprinklers: El Update Existing ❑New System ❑NotReq'd Reason Sprinklers Required: Fire Alarm: El Update Existing ❑New System El Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: FIRE DEPARTMENT Separate / 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/PLUMBING Additional Notes: (J Approved By: Date: . Q , - 2 3 PLANNING Intake OK by: Assign To: Date: Intake Comments: 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: Amount $ School Impact Fee: Total $ Calculated: Credit: ❑Everett School Dist ❑Mukilteo School Dist Park Impact Fees for permits applied for after 1/1/2022: Park Impact Fee Total $ (net due after credit for existing uses) Fee Schedule Used For Calculation (Year): Additional Notes: Approved By: Date: PUBLIC WORKS Intake OK by: Date: Intake Comments: PW Review & Worksheef Needed if.• []Sys Dev Evai : ❑Water []Sewer []Storm ❑Traffic Mitigation Eval ❑Site Work/Drainage (shown/triggered) ❑Address Letter ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, supportive housing) ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items ❑ A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is fully digital ❑ Is located in this folder ❑ Is in a Separate Green Folder Qoin with this folderfor permit issuance) ❑ Will be Issued Separately (Separate Green Folder, PW issued ahead of Bldg) ❑ Public Works has no scope on this permit --- PW Not Required Additional Notes: Completed By: Date: