2117 VIRGINIA AVE 2026-04-10 - Laserfiche WebLink

DEMOLITION PERMIT APPLICATION EVERETT SUBMITTAL INSTRUCTIONS: OF EVERETT PERMIT SERVICES 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET I I ) ' r h " (J PARCEL#: CITY STATE l,(,) IT ZIP SUITE/UNIT#: FLOOR M ADDITIONAL LOCATION INFORMATION: TENANTIBUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: CL ` ' ` V\ . Y 1''- f \ C (7 <[ S OWNER MAILING ADDRESS: STREET 1 I \ n, \J �" CRY U�J( -E`I STATE 1 zip C, U OWNER PHONE: cJ —.3 OOL, JOWNER EMAIL: _�J) F"- C CONTRACTOR CONTACT NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: ICONTACT PHONE: CONTACT EMAIL: DEMOLITION PERMIT INFORMATION VALUATION OF WORK:$ , e, n ASSOCIATED PERMIT/LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair Mrkel value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial Accessory Structure DESCRIPTION OF WORK: #OF SQUARE FEET REMOVED: #OF DWELLING UNITS REMOVED: r c. HISTORIC STRUCTURE: ❑YeS KO (Contact Plan Ing Division to learn about additional requirements for historic structures(on Historic Registry or localed in a Historic Overlay)). SHORELINE/FLOOD PLAIN PROXIMITY:❑YeS 0(Contact Planning Division to learn about shoreline and Iloodplain requirements if structure being demolished is oniin either). EXISTING UNDERGROUND TANK: No Tank ❑Yes tank will stay in place-type: []Yes-tank to be removed-type: UNDERGROUND TANK SIZE:,Oho Tank ❑Under 10,000 gallons ❑l0,000 gallons or over PEDESTRIAN PROTECTION NEEDED: ❑Yes o (Required when demolition is in close proximity to R.O.W.Include a pedestrian protection plan for review). CONSTRUCTION FENCING NEEDED: ❑Yes ONo (If yes,show the temporary construction fencing location on the required site plan). DUMPSTER IN R.O.W. NEEDED: []Yes ONo (If yes,apply for a separate Traffic Street Use Permit online at pw.everettwa.gov). TRAFFIC CONTROL PLAN NEEDED: ❑Yes 8No (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 No (If yes,a separate Utility Permit will be issued for side Sevier cap off prior to demolition). 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). ELECTRICITY CONNECTED TO BUILDING: ❑Yes No(If yes,apply for separate Electrical Permit for disconnect and disconnect services prior to demolition). ABATEMENT ACKNOWLEDGMENTS: The applicant is rosponsible 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 owner/applicant,acknowledge my responsibility,agree to the terms and conditions of tune requirements,and will abide by the requirements during constriction. Asbestos Abatement:Required in line with Puget Sound Clean Air Agency(PSCAA)https://pscleanair.gov/.An Asbestos/Demolition Notification must be submitted PPSCAA before any asbestos removal or demolition begins and have the appropriate abatement report documentation on-site during construction. l� L t3 Paint Abatement:Contact the Snohomish Health District(SHD)htips:IlrAnv.snohd.orgl for applicable lead paint abatement requirements. Rodent Abatement:Proper ror;ent abatement sh If be conducted prior to demolition. SITE PLAN REQUIREMENTS: Submit 2 hard copies of site plan shoving 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 inseparate,compiled pdf,8.5xl 1 or 11x17 size.Naming convention: Address_DemoPermilPlans. ACKNOWLEDGEMENT:I have reviewed this application and confirin the information 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/ani authorized by the owner of this property to perform the work for which application is made, and I corn I with the State Contractors Law 18.27 RCW and 296.200A IVAC. City of Everett Official Use Only r~ S PERMIT# Owner Authorized Agent Signature Date (Revised 412112022)