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DEMOLITION PERMIT APPLICATION <br />EVERETT <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop of hard easy paper eppllmdon Splen b3MD Cedar Slreet2nd Hear Intake Drop Box. <br />WASIONGTOR <br />cONTACTINFORMATION: (P) 42525188101(E) evereltepsQwereNxe.gw I (W) monettea gympermXs <br />(Blue or Black Ink Only Please) PRO.IECT SITE INFORMATION <br />PROJECT SITE ADDRESS: srasas 118m SRw Lam Dr PARCEL#: 2110.58000100200 <br />CITY STME m <br />BUITDUNITC FLOORM ADDITIONAL LOCATION INFORMATION: <br />TENANTIBUSINE8S NAME (if non-residential): <br />CONTACT INFORMATION <br />OWNER NAME:Otyd Evemt <br />OWNER MAILING ADDRESS: smaaTw2 E MuNlteo Blre <br />my Everett vromet WA an 9FING <br />OWNER PHONE:425328J591 <br />JOININEREMAILIDuthatennedminSeveralwaaw <br />CONTRACTOR CONTACT NAME: <br />WASTATE CONTRACTOR LICENSE NREQUIREO: LITVOF EVERETTBUSINESS UCENSEAREONREDi: <br />CONTRACTOR ADDRESS: mmEET <br />CONTRICTORPHONE: CONTRACTOREMAIL: <br />PRIMARYCONTACT: dJOWNER ❑CONTRACTOR ❑OTHER(Please Bpec#y) <br />`°NTAC NAME:Dean Shaughnessy CONTACTPHONE:g6 Bd59ot <br />CONTACT EMAIL: pmau9Aw¢ry®ewratlwagw <br />DEMOLITION PERMIT INFORMATION <br />VALUATION OF WORK: E1Ds,mD JASSOCIATED PERMIT/1-AND USE PROJECT# <br />Iimde: <br />dl <br />wvOCommerckl <br />gOTmenboose aODbmElMW14milFa <br />BUILOINGTYPE: OSFR D u ar ADu —#Unlls: ElAtusassoryStrudure <br />DESCRIPTION OF WORK:AnCeslas Abatement; Underground Tank Removal; Demoklion end Disposal of 22003F Residenm <br />OF SQUARE FEET REMOVED: does $e <br />H OF DWELLING UNITS REMOVED:i <br />HISTORIC STRUCTURE: DYesZNo(r'anuu Pnnnmp InAmn to Imo smut wicifty,111mcdamerm, mattersten themew mmmt euaRel" mulaa lire index, w aemy). <br />SHORELINEIFLOOOPLAIN PROXIMITY: mYes DIc No mw penning DNbbn n mom ewes ai x One and enambm reeaneme a tlewewra bdm ammloed In ma. shed. <br />EXISTING UNDERGROUND TANK ONo Tank ElYes- fork Wil May 1n Amat -tyine: I1Ym-fork ke to removed - type: Sroro at <br />UNDERGROUND TANK SIZE: DNo Tank OUnder10,00Dgallons 1110,000 gallons or wet <br />PEDESTRIAN PROTECTION NEEDED: DYes [Z]No (Requlrea Men aamd8lan Is In doge pmtlmlfy W R.O.W. Include peae¢Iaan protection Pan be revle <br />CONSTRUCTION FENCING NEEDED: [Z]Yes LINT (If ye¢, sMwntetemperery un¢guWan krranp locetloncn 1M1e regolretlsl@ pin4 <br />DUMPSTER IN R.O.W. NEEDED: DYes ONO (Ryes, appryrore eammW TmMc stint Daa Pxmlt omine otpw.werellww.gml <br />TRAFFIC CONTROL PLAN NEEDED: DVes ONO Faculma Men ¢Nmxlk peed lava, or moved rang Bosun is meaad. <br />If yp, appy far s erynreb TtaMo fast Use Permit mime at prv.ewreMre.OovM1 <br />SEWER SERVICE CONNECTED TO BUILDING: OYea DNO (Ilyes, a ¢eperam UG9Y Pont be Isswtl an BIM aeaerwp BH pnot W demolton). <br />WATER SERVICE CONNECTED TO BUILDING: DYe3 Ohio Ufy , wpm bah ¢Ibdmehrpror W demoWlon and molest tho rly Billing W akpbillinan <br />ELECTRICITY CONNECTED TO BUILDING: OYu Ohiollfyw, appyforemxaW Elestirsl Pom8 Wrtli¢wnned eMdemnnad aervlmapror W Mmotltkn4 <br />ABATEMENT ACKNOWLEDGMENTS: the appleanl is t+aponaLN lmmmppmas anfM1 eHncel. elms, antl hderNlewe. sgaea enaregmexmne MelM1xxnot <br />aexrhedeereW. ByM¢eNMg Me Mxnexl to each ebrtementheas bebw,1. MeoxnMpplkanl, mNnaMadWmyniponalblMy, some fern@ M1rmiendmnmigmew of Me <br />umman same aawtle by fire twlre rmaes damn mnamaefi^n. <br />nmuNle aulmXea <br />lunemumm, <br />ggaand ANwy@theerypp(pmeqeuMblstatement <br />i) Is PWMe tAforbbaleany min:mRpatesu¢nremsM in Imi aderPMagAlynN$tablesvalrpawr/MAWeaIOYDwduring <br />m Lead Paint AbelemomCmlatthe dranks Tamq(SHO)po,ppa®tlaletlpXlatlemenitpulmmentsb. <br />❑ Rodent Absentee, Pmmr random ebebrad¢bll M demanded star W barman, <br />SITE PLAN REQUIREMENTS: Bubmlt 2 hand mplm mho plan Nwhg buildings, W be aemdi¢Mtl MM1 wmgt mplkalbn as domain Intake Own Bay or ewdr <br />elecmonr silo Penn vath permll opposition If¢ubinand electranWdly.Plans sholl be In separate. compiled W. 0.501 or I Iof7 sum Naming mnven5xr: <br />Atltlm¢¢ DbmoPmn1Pbne. <br />' maep{NaewnmamwrnmanrcwnxWn mmanaanerwtn nueemmmn.wrn amepmeaenrroruelnnrvtmurmrryoy den <br />nmxn MMN, sure, xiafmafbw. me Pemlmmapermnwuyewnmmaeppmuewam anew Maldwna Inxanxa BedmAxmmaedmlM.wmmadln MMg rrmn lire <br />ertlMn amdmcerxa cexq amm�aamIXv am/Nnrmeenme.lamllw minx. mf.m.mnmmebrauoaywmuaawmemymwMrn m. won:axaatn elstlaxmnbm.M <br />and f maWy warn me sou cgxmdam Lot ten acw era zm gmA mac <br />caymExmn olmx man Doty <br />PERMMIIT## <br />Dean Shaughnessy y2 D 001 <br />OwnxlANM1orind Agent Slgnatare we (MMediMMp1J <br />(DScz PU72zd -IDDb <br />