10600 HOLLY DR 2023-08-23 - Laserfiche WebLink

EVERETT WASHINGTON DEMOLITION PERMIT APPLICATION 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) 425-257-8810 1 (E) PermdSeniices(@_everettwa.gov I M4 everettwa.(iovloermits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET e:)If % tZ_ PARCEL #: QQ SS23 i Cif' �%_ STATE (,() zip 2 SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION: TENANTIBUSINESS NAME (if non-residential): CONTACT INFORMATION OWNER NAME: /L7 OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: — JOWNER EMAIL: LA4_e)C_ \--C�� I r—,p C L� CONTRACTOR CONTACT NAME: ` WA STATE CONTRACTOR LICENSE (REOUIRED)a."a•'1 °" \A)'I CITY OF EVERETT BUSINESS LICENSE #(REQ ED): CONTRACTOR ADDRESS: STREET '( i �j kn) ,. CITYSTATE CONTRACTOR PHONE: _ 931n — o' j d�5 ICONTRACTOR EMAIL: PRIMARY CONTACT: 0OWNER C*CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: S A-'4tP3LLL ICONTACT ICONTACT PHONE; , e1 _ ' (oS(n EMAIL: jj4akZte k DEMOLITION PERMIT INFORMATION VALUATION OF WORK: $ (") ir:�Z9 . � ASSOCIATED PERMIT/LAND USE PROJECT # (dapplicable): (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: EWR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: L nu 3 , # OF SQUARE FEET REMOVED: # OF DWELLING UNITS REMOVED: / HISTORIC STRUCTURE: ❑Yes 54No (Contact Planning Division to learn about additional requirements for historic structures (on Historic Registry allocated in a Historic Overlay)). SHORELINE/FLOODPLAIN PROXIMITY: ❑Yes LINO (Contact Planning Division to learn about shoreline and gaodplain requirements 4 structure being demolished is onkn either). EXISTING UNDERGROUND TANK: 19No Tank ❑Yes- tank will stay in place - type: ❑Yes- tank to be removed - type: UNDERGROUND TANK SIZE; Flo Tank El Under 10,000 gallons ❑l0,000 gallons or over PEDESTRIAN PROTECTION NEEDED: ❑Yes 5allo (Required when demolition is in dose proximity to R.O.W. Include a pedestrian protection plan for review). CONSTRUCTION FENCING NEEDED: ❑Yes ®No (If yes, show the temporary construction fencing location on the required site plan). DUMPSTER IN R.O.W. NEEDED: ❑Yes EhNo (If yes, apply for a separate Traffic Street Use Permit online at pw.everettwa.gov). TRAFFIC CONTROL PLAN NEEDED: ❑Yes WNo (Required when sidewalk,. parking lane.. or travel lane closure is needed. If yes. apply for a separate Traffic Street Use Permit online at pw.everettwa.gov). SEWER SERVICE CONNECTED TO BUILDING: ❑Yes XINo (If yes, a separate Utility Permit will be issued for side sewer cap off prior to demolition;. WATER SERVICE CONNECTED TO BUILDING: Dyes ®No (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 ovmer7applicant, acknowledge my responsibility, agree to the terms and conditions of the requirements, and will abide by the requirements during construction. RIN Asbestos Abatement: Required in line with Puget Sound Clean Air Agency (PSCAA) https Itpscleanair.gov/. M AsbeslosiDemolition Notification must be submitted to PSCAA before any asbestos removal or demolition begins and have the appropriate abatement report documentation on -site during construction. Lead Paint Abatement: Contact the Snohomish Health District (SHD) htips:llwww.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 of 1 1x1 7 size. Naming convention: Address DemoPennitPlans. ��• • •�..«�� 4lwc, i navy revmwao ous appncaion ana wnnrm me mromianon contained herein is true and correct. Work done pursuant to this permit must 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 1 comply with the State Contractors Law 18,27 ROW and 296.200A WAC. City of Evere# Official Use Only TC-) ITZZC Date (Revised 41212022)