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DEMOLITION PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Drop of hard copy paper application & plan W 32M Oscar Street 2ntl Floor lntlke Drop Box <br />CONTACT INFORMATION: (P) 425-257-88101(E) PermftSeMces®everetlwa gav I (W) everelMa.gov/permits <br />(Blue Or Blacklnk Onty Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS E ET amtaanMsE PARCEL a: coodeareanded <br />C Evaell yTATIE WA xIv ranne <br />ry <br />SUITEIUNIT N: made n FLOOR a: ADDITIONAL LOCATION INFORMATION: <br />TENANTMUSINESS NAME IF non-residential): <br />CONTACT INFORMATION <br />OWNER NAMEdan,yeal <br />OWNER MAILING ADDRESS: <br />our Wlmpb A zip Word <br />OWNER PHONE: dxo Neawa <br />JOWNER EMAILdwe+rwu.r@mm.awnm <br />CONTRACTOR CONTACT NAME: Jwd xnrlded <br />WA STATE CONTRACTOR LICENSE #SEOUIREDt:WECmeopzamv <br />CITY OF EVERETT BUSINESS LICENSE PRE➢UIBED): aam <br />CONTRACTOR ADDRESS: <br />ry E�Ihyft �TAM Pay ZIP you <br />CONTRACTOR PHONE: dzm WO3111 <br />1CONTRACTOR EMAIL:Iomars,hosdploow.cwn <br />PRIMARY CONTACT: ❑QWNER 17 CONTRACTOR O OTHER (Please Specify)'""^'� <br />CONTACT NAME: <br />Scott Wooster <br />CONTACT PHONE: PZNsllz-9oae <br />CONK ACTEMNL: ogre mwxl n. <br />DEMOLITION PERMIT INFORMATION <br />VALUATION OF WORK: E ILAW JASSOCIATED PERMIT/LAND USE PROJECT g(eWmyWle{ <br />je <br />rVawatial Are I me prevallmq fair market valua Of all labor anE eouOmemneaoeEbwmpletetrve wdrM,wn uallVwlEwnm] <br />aNOADU <br />BUILDING TYPE: ®SFR OTownM1ouse ODu Iex OMulti-Family of Units: OCommemial [3finfressorriStructurry <br />DESCRIPTION OF WORK: Dearrodlon and renmal of sham damaged doude title manNaWrM home <br />tl OF SQUARE FEET REMOVED:,sa <br />k OF DWELLING UNITS REMOVED: I <br />Hm <br />HISTORIC STRUCTURE: OYes Of (co �(on na Reantn ended). <br />re <br />SHORELINE/FLOODPLAIN PROXIMITY: OYes ONO Axwed Man" Dam mbwutm And nadmam rionemes g ew reberpsynd worm nap. <br />om <br />EXISTING UNDERGROUND TANK: ONO Tank OYMI hank will stay in place - type: OYes-hank to be removed - type: <br />UNDERGROUND TANK SIZE: ONOTank O Under 10,000 gallons 010,000 gallons Or Over <br />PEDESTRIAN PROTECTION NEEDED: OYem ONO (Required when demolition be In dose oredmgy to R.0 W. Include a pedestrian MM=n Man for review). <br />CONSTRUCTION FENCING NEEDED: OYem ONO (If As, dare the temporary construction fendng location on the required site plant. <br />DUNIPSTER IN R.O.W. NEEDED: OYes Of (If May. apply for a sepamha Traffic Street Use Permit online at pw.ewmeM gw) <br />RAFFIC CONTROL PIAN NEEDED: OYes ONO (Required oaten sidewalk, painting lane, diamond lane Mi is needed. <br />If As. apply her a impede Traffic Spent Use Permit online at W'. eret tFov) <br />SEWER SERVICE CONNECTED TO BUILDING: ®Yes ONO (If All a separate Uglily Permit will borrowed br eNe Masai off III demollbram <br />ATER SERWOE CONNECTED TO BUILDING: OYes ONo (IfyeA cep el b¢k sOe of meter prior to de olMon and mM d Ml llli g to"billingl. <br />ELECTRICITYCONNECTEDTOBUILDING: ®Yea ONO (if end, apply fix se ae Electoral Permit for disconned and disconnect services prior to demolNon, <br />ABATEMENT ACKNOWLEDGMENTS: The appewntu responvWe lw wmpnarNe with aNbW, safe, a.aratlerauawx codex and eagdadws wlmtne.ornof <br />descrixodlerein. Bydreckmorcha box nartroeach aW nftype below,r, the owneherpl4ant aNrowhHge myWyM`sWAa., ylree WIN terms and contlifions order <br />e hoarmmema and war abrta by fire regdremants dosing constructed. <br />0 Asbestos Abetment Requied'n line on Pa l Sound Clean Air Agoncy FSCAA) hWyJm Ad irbeatAnAmoserYDanulilian NdXk+tion moat be submitted <br />b PSCPA before any extreme inner a direction ba lns end hoe Me gtprommity abatement moon documentation or dudry concluded <br />0 Lead Paint Abatement Conrad tree Srcbadsh Health Md(SHD)ntlpe://wanv.moM1d.argRaeppikable lend palm etdemaa requlremente <br />0 Rodent Abaleme Proper extent ebNemenl shell be conducted poor N ddmdn . <br />SRE PLAN REOU I REMENTS: Submo2 band copies of site plan shooting Wtidings to be remember! WM permit WddkxMkon ro Permll Iran Dmp Race or etlecb <br />eledmnic site Man wth Permit application dwMnitling AeNomrally. Plans shall be in aparehe, compiled ", 8.6,11 or llx1] sbe, Naming ¢nverNm: <br />Address DemMermllPlens. <br />nxeepgiaelron enacmnrm ore ummmerrm mnmmwnemur lamnawcwmd.w care PaenaurbnaeTanmmux mmyymm <br />vumnllederel, e(e(e, entlbOst low The &+^IirgdepaMlcdyeuMatres ePp'cvetluwk eMrodwkWerS Merelmm. dNetMe moattithe erNtodaWM wdn0 /rum Ind <br />BWdng Uhia fb M Megafmcfmwndaanyrrn'wm#ann.ram(Moarar, wlamaurhw¢etl6y Ne Owererd Mu'prcpwlybpeMem Iha wwklw whichappNMwnu coite. <br />aMlwntgywM(Sfaza Cmfncfors Law 18.2]RCWanb 288.2roA WAC <br />dtyWEvemXOMJeIUm OmJ� <br />Dole ZIsign 19 0743 MOTO PEI RMR# <br />Scott Wooster Dole bDg:g Woe r <br />Ovenerlamxxrlaed Agent Signal Date lRenrad N2faa22p <br />