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DEMOLITION PERMIT APPLICATION D ECEUVE <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plan to 3200 Ced eet 2Jk%oo2l5ak?@P3p Box. <br /> WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermilServices@everettwa.gov I(W)evereltwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 2431 Pine Street PARCEL M ervlce <br /> cnv Everett STATE WA zip 98201 <br /> SUITE/UNIT#: FLOOR M ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME:Shirley/Michael Mulvihil <br /> OWNER MAILING ADDRESS: STREET PO Box 5151 <br /> CITY Lynnwood STATE WA zip 98046 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR CONTACT NAME. /A owner <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED); <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ©OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: rCONTACT <br /> NTAT PHONE:206-769-1160 <br /> ShICIe Mulvihill EMAIL:mulvihillsm@gmail.com 1eee9+r <br /> DEMOLITION PERMIT INFORMATION <br /> VALUATION OF WORK:$10,000.00 JASSOCIATED PERMIT/LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ©Accessory Structure <br /> DESCRIPTION OF WORK:Removal of debris from collaped garage <br /> #OF SQUARE FEET REMOVED:5w <br /> #OF DWELLING UNITS REMOVED: <br /> HISTORIC STRUCTURE: ❑Yes ©No (Contact Planning Division to learn about additional requirements for historic structures(on Historic Registry or located in a Historic Overlay)). <br /> SHORELINE/FLOODPLAIN PROXIMITY:❑Yes VINO(Contact Planning Division to learn about shoreline and toodplain requirements if structure being demolished Is on/in either). <br /> EXISTING UNDERGROUND TANK: ❑✓No Tank ❑Yes-tank will stay in place-type: ❑Yes-tank to be removed-type: <br /> UNDERGROUND TANK SIZE: ©No Tank El Under 10,000 gallons ❑l0,000 gallons or over <br /> PEDESTRIAN PROTECTION NEEDED: ❑Yes WIND (Required when demolition is in close proximity to R.O.W.Include a pedestrian protection plan for review). <br /> CONSTRUCTION FENCING NEEDED: ❑Yes O✓No (If yes,show the temporary construction fencing location on the required site plan). <br /> DUMPSTER IN R.O.W.NEEDED: ❑Yes WIND (If yes,apply for a separate Traffic Street Use Permit online at pw.everettwa.gov). <br /> TRAFFIC CONTROL PLAN NEEDED: ❑Yes ©No (Required when sidewalk,parking lane,or travel lane closure is needed. <br /> If yes,apply for a separate Traffic Street Use Permit online at pw.everetwa.gov). <br /> SEWER SERVICE CONNECTED TO BUILDING: ❑Yes ❑✓No (If yes,a separate Utility Permit will be issued for side Sevier cap off prior to demolition). <br /> WATER SERVICE CONNECTED TO BUILDING: ❑Yes ©No (If yes,cap at back side of meter prior to demolition and contact Utility Billing to stop billing). <br /> ELECTRICITY CONNECTED TO BUILDING: ❑Yes ❑✓No(If yes,apply for separate Electrical Permit for disconnect and disconnect services prior to demolition). <br /> ABATEMENT ACKNOWLEDGMENTS: The applicant is responsible for compliance with all local,state,and federal laws,codes,and regulations whether or not <br /> described herein.By checking the box next to each abatement type below,1,the owner/applicant,acknowledge my responsibility,agree to the terms and conditions of the <br /> requirements,and will abide by the requirements during construction. <br /> E ff Asbestos Abatement:Required in line with Puget Sound Clean Air Agency(PSCAA)https://pscleanair.gov/.An Asbestos/Demolition Notification must be submitted <br /> to PSCAA before any asbestos removal or demolition begins and have the appropriate abatement report documentation on-site during construction. <br /> dLead Paint Abatement:Contact the Snohomish Health District(SHD)h(tps://www.snohd.org/for applicable lead paint abatement requirements. <br /> D/Rodent Abatement:Proper rodent abatement shall be conducted prior to demolition. <br /> 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 <br /> electronic site plan with permit application if submitting electronically.Plans shall be in separate,compiled pdf,8.5x11 or 11x17 size.Naming convention: <br /> Address DemolpermitPlans. <br /> ACKNOWLEDGEMENT.,I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> 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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 3 �r 7/24/2023 PERMIT#D2307-008 <br /> Owner/Authorized Agent Signature Date (Revised 4MI2022) <br />