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MISS <br />DEMOLITION PERMIT APPLICATION <br />EVERETT <br />CITY OF EVERETTPERMR SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop Mhard capy paper application 8 Man to 320f) Carter Rura a Fiber Intake Drop Bal <br />CONTACT INFORMATION: (P)4M.25T.88101(El (W)averellwa.gavlpxmW <br />(Blue or Back Ink Only Plaaae) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: EET <br />C4preSS -St PARCELA: <br />Cm <br />20 <br />SUITEIUNITk: FLOORR: ADDITIONAL LOCATION INFORMATION: <br />TENA MUSINESS NAME IF nw-fealdenW1): <br />CONTACT INFORMATION <br />OWNERNAME: <br />Filli OL <br />Q If <br />OWNER MAILING ADDRESS: g �j <br />easy v Gt} <br />,a IAr a? 4I52D <br />aM <br />OWNERPHONE: /LZ O <br />OWNER Efill Q <br />CONTRACTOR CONTACT NAME: Q.T <br />WA STATE CONTRACTOR LICENSE I'(REQUp D): ICWWEYE BUSINESBLICENSEWEWIRMY <br />CONTRACTOR ADDRESS: rural <br />can mark <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑WHER(Pleaee SpeGty) <br />CONTACT NAME: <br />gAW—B sS auzHtr <br />CONTACT PNONE: <br />CONTACT EMAIL: <br />DEMOLITION PERMIT INFORMATION <br />VALUATION OF WORK: F '00 ASSOCIATED PERMRILAHO USE PRWECTRPaAg,e: <br />Nan.mn nn.11law. amaq.ipamnaw.amaorrr. uevo+..n.u.r.aW <br />mr <br />w.lp.r.veanel+man.lnhadarlen.,�w.lala <br />BWLDINGTYPE: FR OTowtilmese ODu lea ❑AUU OMUN-Fam -M Units: OConnartlel a $IUMre <br />DESCRIPTIONOFWORK: .MO(; (.(OY\ OQ WIv4— <br />N OF SQUARE FEET REMOVED: Flits <br />R OF DWELLING UNITS REMOVED: 11 <br />HISTORIC STRUCTURE: I Was ONO(Gnlem sharing Di mloem about WlWnalrpukammnarMbRawraw am Harris npkby arwumE N a wxMa Mhall. <br />SHORELINEIFLOODPLAIN PROXIMITY: Yes Iihi Fallen, phase m Nrnawd appeal ante Small growmmanawaam Masdamnlwaama MMx. <br />EXISTING UNDERGROUND TANK: ClimbTank ElYea- lank all slay in pace- type'. ea, tank to be removal - type: <br />UNDERGROUND TANK SIZE: "NesTawkDow""Lan"1U,000 gallons or over <br />PEDESTRIAN PROTECTION NEEDED: Yea 0(Raw red oral demo n is In close anxiety to ROW. Induaa a pedestrian primakn pan ter mNaj <br />CONSTRUCTION FENCING NEEDED: 11Vee 12110 (If yea, a bow the temporary ormarwtmn fencing local on the boulred she pant. <br />DUMPSTER IN R.O.W. NEEDED: �Yaa fana,opWyfor 2 mrkrun Traffic street use Permit online at pw.everetlwa.govt. <br />TRAFFIC CONTROL PLAN NEEDED: OT'm O(Required wfien aideweik, perking lane. or (revel lane dcauro Is nautlatl. <br />If yea, apply for a separate Than Susan this Permit online of pw.avemiMa.pwt. <br />SEWER SERVICE CONNECTED TO BUILDING: E)Yes INNo (If emn a separate wiry Permit vall be Issued tar Shia"oral rep on prior 10 aegelNml <br />WATER SERVICE CONNECTED TO BUILDING, El opfem. cep at bank side of mate- prior toaemdlpon and cmlat Any thinginstop ailing). <br />ELECTMCITY CONNECTED TO BUILDING: jhas O(if says may In separate Elactaml phone be dlscnnxl and dbwMaG Srni prior to decal <br />ABATEMENT ACKNOWLEDGMENTS: TM epplkam Is reappna0arormmpllenen rmM1 aNklra.', Hera eMkdwel Nwa aria, eMregualMne wYamezwlM <br />daScdaes MmM. aycMckup; the Am nexlb each abatementype below, I, tM1sovmerhpppcen6 ecknaetl mymaynaMy, appears the lermsedmra111med8ro <br />nonmet uxa and alp same by the regummmh during cansbuctmn. <br />Asbestos Abemme nt: RagulIn line with Pusan bound Clean Nr All Parma) hap, An Asbeslml0emdlgon obligation cowl N Wtmblea <br />m PSCM Mareany aMtica removal or dnmbtitim begins a no have the aparna lmetal permit dammemmlom on done cool dim. <br />ty. <br />Load Paint Abatement: Gnarl Pe mail Al Dlsost (SHD) shefibmw,naptlugl for app'imde hied paint ethernet opposability. <br />Rodent Ambrmene Pmgr mdem sWmale a all tea moral later to dem]Ilbn. <br />SITE PLAN REQUIREMENTS: Submit heal copies of she pan strul bdMlnpa m be demdnhad an among mgliMbn to Permit Inake Ump Rv or etatlt <br />sladmnic she pan ago "nit mislual If Washing mechanically. Pane shall be In normalcompiad ran, goal 1 or 11x1T size. all som'anlMn: <br />Mdmss OemrlPermhPans. <br />ACNNOMEOCEMENT f hew reveal we smalkalM Wed amfum IM MMmelbm mnesed Mmm M may SW Oil WOM Mla pumanl to Iha pammM1 must comply she <br />meal hdel amm, wdbcrog, TM10 manlingofspelm9 wd/euMmma eppmved IwMeMrw dwa0ons Nenlmm.Orvalbvmeal MIbeeNM1uimtlIn Winsotonness <br />wasel Ofibeal balue Mop authorized under any dearpr lame. l am the barer, or l am Imposed by lM easier W tort pmpvly m Podonnlas: it lw Whiten appNeaipn is mades <br />erdlmprytly wort Me$lare CeMraawab, 1827RCWeMA&20001 el <br />Cry Of EvalwOlOpkhl ua. Only <br />xAutnmlreabera Senegal Oea (mweaa&z8zf1 <br />