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MOE DEMOLITION PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Drape OM bard mpy paper application& pan to 32M Cedar Street 2ntl Floor Intake Drop BOX. <br />WASHINGTON CONTACT MFORMATIOW(P)42545T-ter 1(E)P rM$tSeWIMS@evereA .gW 1(WI eeWWIwe.9ae/peFMIN <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECTEITEAOURESS: SMINET 3218 W. MUKILTEO BLVD PARCELM <br />aTx EVERETT STATE WA m 98203 <br />SUITEIUNITO FLOORS: ADDITIONAL LOCATION INFORMATION: <br />TENANTIBUSINESS NAME (B mmresgen0eU: <br />CONTACT INFORMATION <br />OWNER NAME: LIBERATO, LIM S LINDA <br />OWNER MAILING ADDRESS 8TRWT10214 E. CHAMPAGNE DR. <br />an SUN LAKES drkle AZ AS 05248 <br />OWNERPHONE:425-2111-1280 OWNEREMML:I41tdo@Amwsl.net <br />CONTRACTORCONTACTNAME:AARON GLENN <br />WA STATE CONTRACTOR LICENSE AREOUIRED):dCBSrreMP7 <br />CITYOFEWRETTSVSINESSUCENSEN(REDUIRED): SM42 <br />CONTRACTORADDRESS: adderry PO BOX 851 <br />cry MUKILTEO SHAINEWA aP 98275 <br />CONTRACTOR PHONE: CONTRACTOREMML <br />PRIMARYCONTACT: DOWNER OCONTRACTOR ❑CTHERUNIMMo Specify) <br />CONTACT NAME:E <br />AARON GLENN <br />ACT Ion 4 <br />CONTACTE`m amng®tloe 96tcpndcl re.com <br />DEMOLITION PERMIT INFORMATION <br />VALUATION OF WOM$10,000.M ASSOCIATED PERMMAND USE PROJECT M depppmee): <br />a1bnM InW IOe prvvea .WONNA btmrpelele w I.BUILDINGTYPE: <br />aObam aEIADU <br />Ni OTownllouse OMUIII-Farml-MUnled OCommerelal ❑Aresas0 BWclure <br />DESCRIPTION eP WORK:DEMOLiTION OF EXISTING HOME <br />a OF SQUARE FEET REMOVED:'nm <br />a OF DWELLING UNITS REMOVEO:r <br />HISTORIC STRUCTURE: OYes AND lcrnmn mennupprvl:bnwleemeepuumAar nm lorysw:o sauaures(m Hlactlp RegMrywlewunnawaah OveAy)). <br />SHORELINEIFLOODPLANI PROXIMITY: OYest RING penud wAAo-e Mtr SONS amegam reGmremmu aw awt IS DENS) wWho) <br />EXISTING UNDERGROUND TANK: OONOTaM OYea- Iankwilisfeyinplao8-tion' OYes- lank to an ramoveL-type: <br />UNDERGROUND TANK SIZE: ONO Tank ❑Unoer 10,000 gallons E110.000 gallons or oven <br />PEDESTRIAN PROTECTION NEEDED: OYes ONo IRMVIre4 when oemolrlan Is In dose prWi to KDVE bdmG a pooeatom Pttecbaa Iran for WANY). <br />CONSTRUCTION FENCING NEEDED: I]Yea LINO (II ye& show tied lemparery consWRllm fen" loci ion on INS, Toronto site PW I. <br />DUMPSTER N R.O.W. NEEDED: ❑Yea ZING Of yes, apply bra salamte Traffic SlreN USE Perot aAFe at pw.werallxs.al <br />TRAFFIC CONTROL PLAN NEEDED: DYES ONO Unstalreo Men sido- M. pxkinq Wed W travel Moo cbalxe is needed <br />II ya& appty At a aeVBRle Tone, Street Use Permit online at pw.ewmdlwe of <br />SEWER SERVICE CONNECTED TO BUILDING: OYes OW (ifyes, a sepatte Utility Indoor w1l he Instead for and severer cap A grmrm nememdon) <br />WATER SERVICE CONNECTED TO BUILDING: OYes ONa DUANS, cep w back side Of meter plNs M tlamditlan add canted UtiNy HIGH to slop b!NmT. <br />ELECTPoCITY CONNECTED TO BUILDING: OYW ©No (Ilyes, Epplyloreepxete Pledhcal pam!t la tlleamnedantl dscmnew zeMces poarla tlemoFlom. <br />AEATEMENTACKNOWLEDGMENTS: T/re apyf Nis reapmsiWeMmmpM1'enro with aVlu.;xl, alenq endhedesellewAcodaa, xldrepW aNrelhecwnal <br />d"cr2eo Mtn. BychttWng the 0ox nax(baeMnDMemenl type bebw, 1, Me ower�pkmt,, es'knowkopamymap bi ,, ayes to the Nml dmltlplone Mid) <br />reeuemrenla, anJmTabioe by tllemaeimmaMSOAHnpmnNrvcl/on. <br />Aeba61M Ab010nM01: RerutONllRewilllRyatRmntl LlmnAirA9trq(PSCM)Lllps/IVedeaneicbowL MAWealavDem91W NGIrkdlanmualbe submillM <br />W PSCM Meter, any aba me wandemdl ll on Greg and San I no aspepol, bPemont moan dmumonNaan malt¢ tlUhp wrvsN¢bon. <br />❑ Wed Paint Apartment Coi TWA E ud m,uh Renl)r Oi9dird Grind NINE MInvdannal OMl For appnwala lead Most ababrmm tWlmmonls. <br />❑ Rodent Abatement: proper rWenl awbameM Wad no coreat Her to aunolJmn. <br />BITE PLAN REQUIREMENTS: Submi121,artl wyles ulsNe plan sM1oxtnp WIMIn)sb he tlemolislreCstilb prmraWlicallon to Permit lnteke qm Rox w eVeM <br />akalrmia cite plan MlM1 permit applivalmn ileuh,nilMnp nler:INnicelly. PIaM )hell be In aepWele, umpdeo poL a.5x11 ar tixT] aim. Nemil,) cbnvmllpn; <br />AJdnss OemoPmmNPlan. <br />aulmor Indoor I IIA n,elomIfle, <br />ply M Ewtll Odnal fke Orx}� <br />PERMIT 9 <br />pRaN0M M2l sve) <br />