4201 RUCKER AVE COMMUNITY HEALTH CENTER 2019-04-17

Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# SVR 0 9— BUILDING PLANNING Intake OK by: Date: Intake OK by: Date: Intake Comments: Intake Comments: Assign To: ❑ Route to Commercial Building 0 Attach to Project No. ❑ Route to Residential Building 0 Route to Historic Reviewer ❑ Make this a"W"Permit 0 OK to Route to Other Departments Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer Garage/Accessory Struct. Size Zone e-t i A,Q) Number of Stories Overlay/Agreement Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use lAeaico,N Type of Construction Residential Use Occupancy Group Proposed No. of Dwelling Units: Occupancy Load Total No. of Dwelling Units: Fire Sprinklers: ❑Update Existing ❑New System :Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes No Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ Fire Alarm: ❑Update 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 0 No DEverett School Dist ❑Mukilteo School Dist. Add'!RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: VALUATION CALCULATION: Total$ \0\ \'6,©qaE-; `. rJ, Approved By: (7---) Date: G . IC!)`"A- •tO PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: PW Worksheet Need-d if: ❑Sys Dev Eval III Traffic Mit Eval Mite Work o, arainage Proposed Approved By� �y,,r '`_ Date:0074y ❑Backflo "revention for high hazard: (dental, .-dical,animals,mortuary,hospital, suppo. a housing) FIRE DEPARTMENT ❑Route this folder for PW Review at d ---PW Review Worksheet Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate oncurrent PW Review(Green Folder) ❑Route to Fire Drawer---Fire Prelimina Review Notice AND ❑Create Green Folder RI Submitted Previously ❑Deferred ❑Sending Fire Notes to Project Team 0 This Permit is Approved • Public Works Date: (OK to Rout o Other Departments) 0 See PW Review Wor :_heet and associated attached items Fire Sprinklers: ❑update Existing New System 0 Not Req'd 0 A Separate PW P- it is Required (Permit#: PW Fire Alarm: ❑Update Exist' g ❑New System 0 Not Req'd AND 0 Is locate, in this folder Chemical Sup: ❑Update E ' ting ❑New System 0 Not Req'd 0 Is in a `eparate Green Folder(join with this folder for permit issuance) Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: 0 Public Works has no scope--- PW Not Required Additional Notes: ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: