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DEMOLITION PERMIT APPLICATION <br />EVERETT <br />CITY OF ETT PERMIT SERVICES <br />ohif <br />SUBMITTAL INSTRUCTIONS: Drop had way, paper application S plan W 3200 Deal Stra l 2nd Floor Intake Drop Boll. <br />WASHINGTON <br />CONTACT INFORMATION: (P)425-25T-S8101(E) Pe"kServims®everellwa gov l lWl .ear a.gwv mM <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 2215 Merllll ereeN Parkway PARCEL#: 280402W300300 <br />cmEverett eArm WA pip 91203 <br />SUITEIUNIT#: FLOOR N: ADDITIONAL LOCATION INFORMATION: <br />TENANTMUSIM NAME(k non-resklerdiaB: <br />CONTACT INFORMATION <br />OWNER NAME: Polo Popauna <br />OWNER MAILING ADDRESS sl u99 Olympic view Drive <br />m EEmmEa uAmb WA na SBOCO <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR CONTACT NAME:Mazee Network Solutions 0 176 G <br />WA STATE CONTRACTOR LICENSE INREQUIREO):MASTENS868F,Y <br />Cm OFEVFRETTeuSINE44UCENSE#(REDUIR ): (J <br />CONTRACTOR ADDRESS: amount M72 Limonke Avenue 3E-1M <br />cm Easyale MATH CA na 92BUO <br />CONTRACTOR PHONE:949a73-6377 lCONITIACTOR EMAIL LINDA@AMWIRECO.COM <br />PRIMARYCONTACT: ❑OWNER ❑CONTRACTOR DOTHER(PIMS,Specky)Asnr,.mmaas <br />CONTACT NAME: LIN DA WILLIAMS <br />PFMAIL. 7.mm <br />CONTACT n7,9 nZ7r <br />DEMOLITION PERMIT INFORMATION <br />ALUATION OF WORK: TIMOSA w ASSOCIATED PERMITILAND USE PROJECT as atranciso <br />Naw edivalrnprslrxetvebemaleeor. mnerbb,nea u6ma mmgmmewhwnameraauelry pe nnq <br />BUILDINGTYPE:OSFR OTownhcuae DDu lex Q4DU OMuftWami -#Units: DOommercial ®Acwsao SWclure <br />DESCMPTION OF WORK: REMOVE SPRINT GROUND EQUIPMENT FROM MONOPOLE- Sae Attachmei <br />p OF SQUARE FEET REMOW D: <br /># OF DWELLING UNITS REMOVED: <br />HISTORICSTRUGTURE: DYes ®No(WnmalNnn,Oo(.elon,IsamawaaWmnalrpoaememarornimne awanroa Mn xaroiie Repuryaaaea,awamna [nanyl). <br />SNORELINEIFLOOOPLAIN PROXIMITY:LJYes VISIT (canbu vlaenxgo'mabnu Nam aeons s(erwlN and savage., ragdr.mnnk a mnmre Hang damelbned is man cff) <br />EMSTHG UNDEROROUND TANK: ONO Tank OYee- fink will stay in place - type: LJYm-tank W be droved - type: <br />DNDERGROUNDTANKMM: IZINo Tank ElUnder 10,000 gallons [110,000galbnSarover <br />PEDESTRIAN PROTECTION NEEDED: DYes ONO (Feinted when don dl(w is in days poAds to R.OW knows a pe oponan pokslon plan for reassaid <br />CONSTRUCTION FENCING NEEDED: E]Yea VINO (if AS snow tM tance ary cmabuctim tenure vagnon on he regui ails pant. <br />DUMPSTER IN FLOW. NEEDED: DYes ONa(if <br />yes, awls law a sepamre Ton Streit Use Panintusng at pal.evmebwa.gw) <br />TRAFFIC CONTROL PLAN NEEDED: DYes IZNe(Regdred when sid lk paring lane, or travel Iva closure is neN <br />If yes, cagy fail arepasta Taflw Street Use Permit enure at pal.evcM died. <br />SEWER SERVICE CONNECTED TO BUILDING: ElYe s ONo (If year aaewrate Utility Permit will bon Issued br akk sear cap OF prior Eearal. <br />WATER SERVICE CONNECTED TO BUILDING: (]Yes hilNc III rap al6sGside of meter pnwto dervo n and cannot Utility Bllaingto gap billing). <br />ELECTRICRYCONNECTEDTOBUILDING: DYw [?]No Of ye a apply for eryamoe Elmisiml Permit W dlscom and Eistri servier pnor m demoHdom. <br />ABATEMENT ACKNOWLEWMENTS: The applwsa is asymabb Wxmplianw x#n as lrca{ stare, ap hdwallewa mess, aMregulasmsWMefM1erarnd <br />ANSI heron. By checkng Mebox ired to aadl abatement hire Ivibw, 1, Me ortmeNapplkard, eckndMNge my re}rorseft x to Mot Mara and mrMiyl of the <br />repuiArri. and HAS abode by Me bicameral MI bored lob. <br />Asbestos Adatemeo: Reyulred In ane With Puget Souid Clean Air Agency hill tape IlpatlNntlrgoal. M AkAdNMraallllon NOHrrRMn most be balk id <br />A, PSGA babre any asbestos drmvg or dmmNlm begins ands have Me apprtgnale adennent even docurmnl n uraile durlry rcneWdlon. <br />❑ Lod Faint AMwo : caMactlM Snohwnlan Health pabiat(SHD)May, flANG nohdOil M, aq&able lead pint aMenonl WasArmn@ <br />❑ RMwd Amon enk Pyermeent abaremem shall be OdMAd Pnw to dal <br />SITE PLAN REQUIREMENTS: Submit 2 hared copes of sine plan shw.ing buildings m be demdohe win pama All now m Pemra Intake Drop FIGHTor affair <br />elatr m gas plan With Ferrant caffcn if suomitdrg eleNmkally. Plans Mall W in saidere,mnsweld pk,(rSal t Or t t At 7Al Hall wlvercon. <br />dress DemoParutires. <br />NCKNOWIEDGEMENr.'Ihawnvlewed Ml4 egti[efmn anda'wKem memM1uma( cmhlnMne'eln is bee entlmleaL Nbk tlwe W/suanlb MkpmnNmug mmlLy wlM <br />r Vundersides <br />nd4side abed KKalew.The Bening bo a Bane Mry wm me O'Gr S, Ism kandlw devll"ownsaxi . Oevis" mug9 as aWMaetlm wquinow a <br />SOI OM4al ers Mag4uMad[M wlM any Mostlede.I4m MabwnaA wram aumwlaMbytM bwnNormkp'opMropehann Ms naklw uThih apppuFonumaCa. <br />antllamlNy wM lire Shh Mbaatas new fS9FLW eMnB.3wN VIAL <br />cdyalEmNf 011rig Use Only <br />Linda Williams ore :20 i23 18 8 9.ONU <br />12/26/22 <br />PERMIT# <br />OmulAuMori dAgent Signature <br />De@ <br />fReviAITGORp22f <br />