10524 HOLLY DR 2024-08-08 - Laserfiche WebLink

DEMOLITION PERMIT APPLICATION EVERETT WASHINGTON CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plan to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425-257-88101 (E) PermitServices@everettwa.gov I (VI everettwa.govipermits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION G� PROJECT SITE ADDRESS: STREET L o f PARCEL #7yv Qd3 C�C�B CITY STATE (eQ - ZIP 2 SUITEMNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential): S A -:;, CAS 1--. C CONTACT INFORMATION OWNER NAME: 1-� ill OWNER MAILING ADDRESS: STREET S S 1 C CITY CtKIC STATE &t ZT, Lv OWNER PHONE: -`) JOWNER EMAIL: CONTRACTOR CONTACT NAME: WA STATE CONTRACTOR LICENSE)REQUIRED Ai OF EVERETT BUSINESS LICENSE #(REQUIRED). CONTRACTOR ADDRESS: STREET '( i (;Lj A--n „ CITY Q.�,�j{.�'�-�6�-� STATE e4>iZ 21p Cleo W CONTRACTOR PHONE: _ -01(t>25 CONTRACTOR EMAIL:'0 I&p vv-, ` c4Zq� g OtiT I-r-�tt PRIMARY CONTACT: kt OWNER C}IcCONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: q2- CONTACT EMAIL: DEMOLITION PERMIT INFORMATION VALUATION OF WORK: I , c� .c9C9 ASSOCIATED PERMIT/LAND USE PROJECT # (Rapplicable): (Valuation shall include the prevailing fair market value of all labor, materials. and equipment needed to complete the work, whether actually paid or not.) BUILDING TYPE: QiUFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family -# Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: # OF SQUARE FEET REMOVED: # OF DWELLING UNITS REMOVED: / HISTORIC STRUCTURE: ❑Yes b4NO (Contact Planning Division to learn about additional requirements for historic structures (on Historic Registry orlocated in a Historic Overlay)). SHORELINE/FLOODPLAIN PROXIMITY: ❑�gN Yes e (Contact Planning Division to learn about shoreline and Hoodplain requirements d structure being demolished is onfin either). EXISTING UNDERGROUND TANK: NNo Tank ❑Yes- tank will stay in place -type: ❑Yes- tank to be removed - type: UNDERGROUND TANK SIZE; NdNo Tank ❑Under 10,000 gallons ❑l0.000 gallons or over PEDESTRIAN PROTECTION NEEDED: ❑Yes Wlo (Required when demolition is in close proximity to R.O.W. Include a pedestrian protection plan for review). CONSTRUCTION FENCING NEEDED: ❑Yes NNo (If yes, show the temporary construction fencing location on the required site plan). DUMPSTER IN R.O.W. NEEDED: ❑Yes FNo (If yes, apply for a separate Traffic Street Use Permit online at pw.everettwa.gov). TRAFFIC CONTROL PLAN NEEDED: ❑Yes VQNo (Required when sidewalk, parking lane, or travel lane closure is needed. If yes. apply for a separate Traffic Street Use Permit online at pw.everethwa.gov). SEWER SERVICE CONNECTED TO BUILDING: ❑Yes 'Ar7�N�o (If yes, a separate Utility Permit will be issued for side sewer cap off prior to demolition). WATER SERVICE CONNECTED TO BUILDING: ❑Yes END (If yes, cap at back side of meter prior to demolition and contact Utility Billing to stop billing) - ELECTRICITY CONNECTED TO BUILDING: ❑Yes o (If yes, apply for separate Electrical Permit for disconnect and disconnect services prior to demolition). ABATEMENT ACKNOWLEDGMENTS: The applicant is responsible for compliance with all local, state, and federal laws,codes, and regulations whether or not described herein. By checking the box next to each abatement type below, I, the owner/applicant, acknowledge my responsibility, agree to the terms and conditions of the requirements, and will abide by the requirements during construction. Asbestos Abatement: Required in line with Puget Sound Clean Air Agency (PSCAA) htips:Rpsclesnaicgov/. An Asbestos/Demolition Notification must be submitted to PSCAA before any asbestos removal or demolition begins and have the appropriate abatement report documentation on -site during consWclion. Lead Paint Abatement: Contact the Snohomish Health District (SHD) https://www.snohd.org/ for applicable lead paint abatement requirements. Rodent Abatement: Proper rodent abatement shall be conducted prior to demolition. SITE PLAN REQUIREMENTS: Submit 2 hard copies of site plan showing buildings to be demolished with permit application to Permit Intake Drop Box or attach electronic site plan with permit application if submitting electronically. Plans shall be in separate, compiled pdf, 8.5xl1 or 1 txl7 size. Naming convention: Address DemOPefmitPlans. ACKNOWLEDGEMENT. I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit most comply with current federal state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance. I am the owner or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 ROW and 296.200A WAG. City of Everett Official UseOnly PE 2 _(.OeDr Date (Revised 412112022)