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DEMOLITION PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Drop off hand copy paper application& plan to 3200 Carrier Street 2nd Floor Intake Drop Box. <br />WARHINSTON CONTACT INFORMATION: (P) 025-257-MID 1(E) Permit5ervicesWevereUwe.gw l (W) everettwe.gov/permih <br />(BINS or Black Ink Only Please) PROJECT BITE INFORMATION <br />PROJECT SITE ADDRESS: snal A UC / JQ. PARCELM <br />cm <br />m Qiy O <br />SUITEIUNR d: FLOi ADDITIONAL LOCATION INFORMATION: <br />TENANTIBUSINESS NAME (it norwesidentlN): <br />CONTACT INFORMATION <br />OWNER NAME: <br />OWNER MAILING ADDRESS: Into <br />Z <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR CONTACT NAME: Toijavd, F U - <br />WABTATECONTRACTORLICENSE%(REQUIRED): TYOF EVERETT BUSINESS LICENSE pIREQUIRE01: 6i <br />7 ] <br />CONTRACTOR ADDRESS: '7 Y <br />as <br />CONTRACTOR PHONE: C4 2,Q IYAJ 9k3 <br />ICONTRACTOR EMAIL. j caah a 1 Ah ao,Cdew. <br />PMMARYCONTACT: DOWNER (CONTRACTOR ❑0THER(Pleese Spri <br />CONTACT NAME <br />CONTACTPHONE: C2'115) — <br />1 <br />CONTACT EMAIL: <br />o . C car <br />DEMOLITION PERMIT INFORMATION <br />VALUATION OF WOR 'S <br />ASSOCIATED PERMITAAND USE PROJECT B Iy send e: <br />rvaiusuon Malnduee NaPm'a <br />6'm bor.melaew.Brq <br />mMweemmmvelB +rats. nbemereowdNwnwml.l <br />BUILDINGTYPEl DTownhouser DDu lex DADU DMUM-Family-01.1i 1111CommercNl DAaeaeO SWclure <br />DESCRIPTION OF WORK: garjqccek ps tm O ON uni <br />k OF SQUARE FEET REMOVED: <br />P OF DWELLING UNITS REMOVED: <br />HISTORIC STRUCTURE: Dyes ONO (mnmHPt...'nemn.nnmbsm amweadlbnelregniremenb NrnNlwtewdum•pn NxmecRgwyorarobene xbmilcoveneyll. <br />SHORELINEFLOODPLAIN PROXIMITY: Elan ®Np (Gnmm Penning UNlsmn 01 Hmm shmadw and Section mgmramama eamnmm Ise damdH.e beam armed. <br />EXISTING UNDERGROUND TANK: ONO Tank DYes- tank will stay in place - type: 0Yea-tank to Gar removed - type: <br />UNDERGROUNDTANK SIZE: ShoTank DUnder10,000gallons D10,000 gallons orover <br />PEDESTRIAN PROTECTION NEEDED: Dyne MNo (Required when demmibn is In cbxe proxlmlty to R.O.W. Ulduriea paeestran pmteNon plan or remevy. <br />CONSTRUCTION FENCING NEEDED: L]Yea ®No pfyes,showthetempomwx sWdbn Nndngbmtbnmhmretardedsib plan) <br />DUMPSTER IN R.O.W. NEEDED: DYes ONG <br />(Ifyes, apply bar a asp imp, Tough Shed Use Peak aware at pw.everetlxeyovl. <br />RAFFIC CONTROL PLAN NEEDED: DYes ENO Installed when Ndaxalk asking lam, cetmrel lane cbsure b needed. <br />If yes, apply for a sepamU Traffic street Use Permit online at pw.meroHwa.gpv} <br />SEWER SERVICE CONNECTED TO BUILDING: DYes ®No (if yes, a separate Ufity Pmmltwhl be lssuadkrsidesevmrcap off piwrmtlemdilion). <br />WATER SERVICE CONNECTED TO BUILDING: DYes ®No (it yes, cap at back side of meter prior to derni and coined Umity Billing to Hop biting) <br />ELECTRICITY CONNECTED TO BUILDING: DYm END (ifyed. apply for separate Electrical Permit for disconnect and dlsconmd servlms price b demoll <br />TEMENTACKNOMILEDGMENTS: TheeppBcanl leraewnsbb fwsonpliulro xrlh sNbcaL stale,antl/eaemlbws. ro6ex aMngablkMa wM1eMararrof <br />dBsnlbaellereM. eyaM1Bctlnp lMharneJ beets ebetemenl rypebebw,{IM1eo /applkaM,eaknpMetlge my/ea(wnaWlNy. egreeltfM hmw aM waPtioru'ollho <br />reel/rema AartsieNdehyfM �RWNemsMsetrial iSound. <br />r ABEeaMAbaYmenl: Required in line trial PUI1M50Mtl Cben NrpgBnq IPSCNd hllpe//pzbanak.9wl. An bMHaHOBmMXbn NWfiealbn mu•I mewbmltlen <br />b PSCM Mwe erry eMeabe reaYVBI M tlBrtOltlm be�ne arts mares Imo eppmprlale abalemem reparl doeumMprwl meiN d W ry aTB W dims. <br />® Lxtl PHM Abebmia: Carl are leadership Health DlsHcl(SHO)MIpN/wmcenohdorgl forappliad0 bad paint eatement requlmmanls. <br />ROMn1 Annea l: Proper Ment rumored shall be ccndumed Nor to duration. <br />rBITE PLAN REQUIREMENTS: Submit 2 hard copies of site Pan abrading buildings to be denrollahad with peanut appllwgan toPoi Intake Drop Box an anatlt <br />SITE <br />electronic site plan with among initiation If loarmwng alwlronically. Plana shall be in aemrate, compiled aril. B.&II or ttxn7 sea Nar lap ammgon: <br />DemgPemlwam. <br />vr:llww rev <br />dMbtel hew. <br />Cdy d Evemll Olhvl Uw ONY <br />Z9-2`� P � T2208-c02 <br />Pearson abdil 22f <br />