902 N BROADWAY IN N OUT MINI MARKET 2019-05-31

4en. PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION' PROJECT ADDRESS: 902 N Broadway IF APPLICABLE: VI LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.)SEPA Determination of Non-Significance-902 N Broadway SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY TO COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 171 YES, . FROM Gas Station/Retail TO Retail Only NEW WATER/SEWER SERVICE NEEDED? El NO 0 YES,TYPE SIZE SITE WORKi./RIGHT-OF-WAY;APPLICATION;INFORMATION DESCRIPTION OF WORK: Decommissioning and removal of three (3) gas station USTs, and associated piping, dispensers and dispenser canopy. The parking lot will be repaved. No work in the right-of-way. A soil vapor extraction system will be installed to remediate on-site petroleum contaminated soil and groundwater. ❑FENCE IN ROW Perimeter security fence will remain in place FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE co ASPHALT/CONCRETE PAVING Asphalt 14,000 SF ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT p CLEARING/GRADING/FILL/EXCAVATE Excavate 500 (Max) CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION ' OWNER NAME: NAP Management, Inc. Dave Hunter OWNER MAILING ADDRESS: STREET 7525 SE 24th ST, Suite 315 CITY Mercer Island STATE WA ZIP 98040 OWNER PHONE: OWNER EMAIL: APPLICANT NAME: Kane Environmental (Eric Nassau) APPLICANT MAILING ADDRESS: STREET PO Box 31936 crry Seattle STATE WA ziP 98103 APPLICANT PHONE: 206-691-0476 APPLICANT EMAIL: enassau@kane-environmental.com PRIMARY CONTACT: 0 OWNER 4Zl APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 206-691-0476 X3 Eric Nassau CONTACT EMAIL: enassau@kane-environmental.com 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 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# ;S'Ow /tad-Q-aZG 1 0/23/1 7 PW >_/v- O 33-- Owner/Authorized ner/Authorized Agent Signature Date (Revised 9/23/2016)