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DEMOLITION PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Drop of hard copy paper application& plan to 32M Damon Street 2na Floor Intake Drop Box <br />CONTACT INFORMATION: (P) 025-257-88101(E) PermftSeMces®everetlwa g v I (W) eveme ,gwipermits <br />(BlueoFBlacklnk Onty Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: PARCELN: wsar wlw <br />E <br />CIypoll yTATIE WA zip Wore <br />SUITERUNIT N: whole reach man FLOOR ADDITIONAL LOCATION INFORMATION: <br />TENANTMUSINESS NAME IF non-residential):i l'rarmw sae shred, <br />CONTACT INFORMATION <br />OWNER NAME: sx.nwswm.detu <br />OWNER MAILING ADDRESS: <br />cul Ways SAM WA zip ro <br />OWNER PHONE: anaasal <br />JOWNER EMAIL m"Idemaw i examr.mm <br />CONTRACTOR CONTACT NAME: Trees aches <br />WA STATE CONTRACTOR LICENSE#REQUIRED: PHOENUC]af re <br />Crrs' OF EVERETT BUSINESS LICENSE Y(REQUIFED): Mora <br />CONTRACTOR ADDRESS: ap <br />Es <br />comes <br />,rwtm chZIP fare <br />CONTRACTOR PHONE: anainarraC <br />1CONTRACTOR EMAIL:tm.i,lpmnmwndriwdom <br />PRIMARY CONTACT: ❑GWNER 000NTRACTOR 0 OTHER (Please Specify) <br />CONTACT NAME: <br />Travis Johnson <br />CONTACT PHONE: aa+esssss <br />CONTACT EMAILmn,Omaamnwm.rawm <br />DEMOLITION PERMIT INFORMATION <br />VALUATION OF WORK: E eadod.co JASSOCIATED PERMITILAND USE PROJECT N afapp¢celo: <br />aV <br />ryawatial Ann ncluoe me prevallmq fair markeivalue of all labor anE eouOmemneaoeEbwmplatetne wdrM,Win uallywa wnm] <br />aNOADU <br />BUILDING TYPE: OSFR OTownbouse ODu Iex [)Multi - Family -p Units: OCommemml 13Amesso Structure <br />DESCRIPTION OF WORK: Dealt of Ralf service can yet <br />tl OF SQUARE FEET REMOVED: 31. <br />k OF DWELLING UNITS REMOVED:a <br />HISTORIC STRUCTURE: DYes Of (Co res(on nc Reg+try my)l. <br />SHORELINEIFLOODPIAIN PROXIMITY: DYes ONO Axi Many Dlmadnm mbodt maenenAnd dwdma melwarli If StrUl harm demo hen, <br />EXISTING UNDERGROUND TANK: ONO Tank OYes- Link vdll stall in place - type: Oyes -tank to be removed- type e+yry <br />UNDERGROUND TANK SIZE: ONOTank O Under 10,000 gallons 010,000 gallons Grover <br />PEDESTRIAN PROTECTION NEEDED: DYes ONO (RequlreE Wren demolition be In none potentially to R.0 W. Include a exceslrlen Mm=n man Or Pont <br />CONSTRUCTION FENCING NEEDED: OYes l (If yes, dare the temporary construction final location on the required site plant. <br />DUMPSTER IN R.O.W. NEEDED: DYes ONo Of May. apply for a saparlda Trefi Street Use Permit online at pery eexagw) <br />RAFFIC CONTROL PIAN NEEDED: DYes ONO (Required Wren sidewalk, peMYg Tana, ortrovel lane tlwure is needed. <br />If yes, apply her a impe91e Trento Spent Use Permit online at Demarcates tForn <br />BEWER SERVICE CONNECTED TO BUILDING: DYes ONO (If Hall a separate Ul Permit will financed br side aeeerwp off pri derwifirm <br />ATERSERVICECONNECTED TO BUILDING: OYes 0No(Ifyel cepelLicksOeof meter priortodemolMonandmr dMl llligto"billingl. <br />ELECTRICITYCONNECTEDTOBUILDING: ®Yea ONO 0f yes, apply fix yae Electoral Permit for disconned and disconnect services prior to demchicn, <br />ABATEMENT ACKNOWLEDGMENTS: The appVwntu responvWe lw wmpnarNe with aNbW, score, a.aratlerauawx codex aMmguladms wletne.ornoR <br />deacrixodherein. BydrecRrngtha box nertroeach aW nt type below,', the ownedVPrAdi a*mMWde myreaponaibser. ylree WIN Rama and conditions o/Me <br />mmlremmRs, and nor aelde by pre regrdmnrents dunng mnamcrdn. <br />0 Asbestos Amement. Requied'n line on Pat Sound Clean Air Agency PSI hQpllpeg iegel. An AmAtarDanulilian NolXkation moat be au anchor <br />b PSCPA herder any asbntw rmoval adommition begins ant have Me gtprc amity ebaamenl upon documentation our dudry mreWtlion. <br />0 Lead Paint Abatement Conrad Me SnohomKh Heals Dabcl(sXDt ntlpe://wanv.moM1d.argRaapmMable lend print amtmad ralulremente <br />0 Rodent Abaleme Proper Parent ebaemenl shell be conducted pox M dd da . <br />SOE PLAIT REQUIREMENTS: trained nand copies of site plan shooting Luudings to be confirmed With permit applkation m PermB intake Dmp Roe or adaeb <br />eledmnic site Plan With Permit application awMaNing eleNoarally. Plans shall be in oW mle, compiled pant, 8.6,11 or llx1] she. Naming "vaMm: <br />Address DemMermllPlens. <br />naeepgpdelron enacmnrm ua ummmerlm mnmmwnaan lamnawcwmn.w core Pu'eflactbnaePanmmux mmyy rem <br />contemporary'Offmibeivend baalew Tlu&dffny,moml euMaosamer. weI eMrodwkWrlS tneulmm. dNatMe moat Mthe eWwdaWMwdn0 /rum IM <br />BWdmp OfiyheirfMa Me CommnretlLawaany,iCA'saynn. l an (Moarar, wl amaulha¢etl6y Me ownrerd Mu'prcpalyfa peMrm (he waklw whichapPNMdnu coite. <br />aMlwnyYy mlll(MSfaza Cmfncfors Law f8.2]RCWana 286.2roA WAC <br />dtyWEvereXOMJeIUm OmJ <br />Digitalry sienea by Bervkn PERMRk <br />Brandon DeBerry DeBan <br />Data: 2oz3.oa.oB la:n:ae o]'oo' <br />own.nambana.a Agent Nenaam Date (Raauaaazfaaxx7 <br />