10821 19TH AVE SE PNW PHYSICAL THERAPY 2019-07-25

C4 Intake&Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# EX l 2 - 0.3C) 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 Number of Stories Overlay/Agreement Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use 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? Dyes ❑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 ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: VALUATION CALCULATION: Total $ Approved By: Date: PUBLIC WORKS Intake OK by: Date: Additional Notes: Intake Comments: IPW Worksheet Needed If: :OSys Dev Eval ❑Traffic Mit Eval ©Site Work or Drainage Proposed Approved By: Date: =DBackflow Prevention for high hazard: :(dental,medical,animals,mortuary,hospital, :supportive housing) FIRE DEPARTMENT ❑Route this folder for PW Review at end --- PW Review Worksheet Intake. (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review (Green Folder) ❑Route to Fire Drawer---Fire Preliminary ReviewNotice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items Fire Sprinklers: ❑Update Existing Chew System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) Fire Alarm: Update Existing ❑New System 0 Not Req'd AND 0 Is located in this folder Chemical Sup: Update Existing ❑New System ❑Not Req'd 0 Is in a Separate Green Folder (join with this folder for permit issuance) Additional Notes: / El Willbe issued separately (Separate Green Folder,PW issued ahead of Bldg) Approved By:�/y: '?(J Date: /'Z/ 7/- CI Works has no scope--- PW Not Required / Additional Notes: /ELECTRICAL Additional Notes: Approved By: Date: Approved By: Date: f/Z