1424 108TH ST SW 2024-07-01 - Laserfiche WebLink

DEMOLITION PERMIT APPLICATION EVERETT SUBMITTAL INSTRUCTIONS:CITY OF EVERETT PERMIT SERVICES ONS:Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION:(P)425.257.8810 1(E)everetteps@everettwa.gov I(W)everettwa.govlpermits (Blue or Black ink Only Please) t PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET ! e, '}Ll i 1 t y' PARCEL M CRY j ,'v '� �;' -� STATE. UUZIP ,r . SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): 1-1 CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: sTR aT f ! j 't "j W CITY l.W. fj. 6=5 STATE J ZIP OWNER PHONE: " -�� - G , OWNER EMAiL: ;et j '41 kc ko e, it; I. CONTRACTOR CONTACT NAME: i QV WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE 4(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRi1CTOR EMAIL: PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: DEMOLITION PERMIT INFORMATION VALUATION OF WORK:$ 10 OC) 12-0 ASSOCIATED PERMITtLAND USE PROJECT#(if applicable): (Valuation shat€Include the prevaring fairs market value of all labor,materials,and equipment needed to complete the%vork,whetheractuualty paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units:_ ❑Commercial NAccessory Structure DESCRIPTION OF WORK: C CAy?0VT #OF SQUARE FEET REMOVED: lj cox X #OF DWELLING UNITS REMOVED: I HISTORIC STRUCTURE: ❑Yes WNo (Contact Planning Divislon to team about addittonat requirements for historic structures(an Historic Registry or located In a Historic Overlay)). SHORELINE/FLOODPLAIN PROXIMITY:❑Yes IRNO(Contact Planning Division to learn about shoreline and floodplain requirements if structure being demolished Is ontin either). EXISTING UNDERGROUND TANK: [RND Tank ❑Yes-tank will stay in place-type: ❑Yes-tank to be removed-type: UNDERGROUND TANK SIZE: No Tank ❑Under 10,000 gallons 01 000 gallons or over PEDESTRIAN PROTEC'M QN NEEDED: ❑Yes No (Required when demolition is in close 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 yNo (If yes,apply for a separate Traffic Street Use Permit online at pw.evereltwa.gov). TRAFFIC CONTROL PLAN NEEDED: ❑Yes YNo (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 V]No (if yes,a separate Utility Permit will be issued for side sewer cap off prior to demolition). WATER SERVICE CONNECTED TO BUILDING: ❑Yes No (if yes,cap at backside of meter prior to demolition and contact Utility Billing to stop billing). ELECTRICITY CONNECTED TO BUILDING: ❑Yes No(it yes,apply for separate Electrical Permit for disconnect and disconnect services prior to demolition). ABATEMENT ACKNOWLEDGMENTS: 7'he 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,1,the ownerlapplicant,acknowledge my responsibility,agree to the teras 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)tittpsJIpscleanair.gov/.An Asbestos?Demolition Notification must be submitted to PSCAA before any asbestos removal or demolition begins and havo the appropriate abatement report documonlation on-site during construction. Lead Paint Abatement:Contact the Snohomish Health District(SHD)https:ifvA-Av.snohd.orgl for applicable lead paint abatement requirements. Rodent Abatement:Proper rodent abatement shalt 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,8.5x11 or 11x17 size.Naming convention: Address DemoPermitPlans. ACKNOWLEDGEMENT 1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with current federal,state,and local law.Tho granting of a permit only authorizes approved work and no deviations there From.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.t 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 wit the State Contractors Lacv 18,27 RCW and 296.200A WAC. f City of Everett Official Use Only PERMIT ft Ow6erltlitllidrlzed Agent Si nal re Dae (R,evised 2/812021)