HomeMy WebLinkAbout6205 188th St Ne_BLD05-6723_2025 C I TY QF ir=1RL I hlGTOh!
CUP-1E;-IF RUC-T I Oh! PERM I -F
PE Ft I T IVC]_ = mS—b 723
Owner: ARLINGTON CITY OF 238 N OLYMPIC AVE ARLINGTON 98223
Value of Work: Tax ID: 15310540120009 Phone: 360 435-0724
Describe Work: DEMO EXISTING BUILDING
Proposed Use:
Legal Description:
Job Address: 6205 188TH ST NE
Contractor's Name Type Address License#
CORRECTIONAL INDUSTRIES GEN PO BOX 99965 01233
TOTALS Fee
Permit Fee $0. 00
SIGNATURE:
TOTAL FEE. . . . . . . . . . . . . . . . . $0. 00 ILEREBY C i�'V HAT I HAVE READ
D EXAMINED THIS APPLICATION AND
PAYMENTS. . . . . . . . . . . . . . . . . . $0. 00 NO THE SAME TO BE TRUE AND COR-
ECT ALL PWEVIS
F LAWS AND
TOTAL DUE. . . . . . . . . . . . . . . . . $@. 00 RDIIANCE THIS TYPE OF
RK WILL WITH WHETHER
D DATE RECEIPT # -
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Y °� DEMOLITION SUBMITTAL
7� o CHECKLIST
C1NG"% Department of Community Development
City of Arlington • 238 N Olympic Ave. •Arlington, WA 98223 • Phone (360)403 3431 - FAX (360)403 3447
Use this checklist to ensure that all necessary information is
provided for review of your project.
Requirements for Submittal
A completed demolition permit application
Two (2) sets of accurate fully dimensioned plot plans
Two (2) sets of asbestos abatement reports
Required Inspections
Termination of Utilities
i Provide documentation of hazard disposal at final inspection
r Final site inspection when demolition is completed.
24-hour Notice of Request for Inspection
Call the 24-hour inspection line (360) 403 0674
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Forms/chklst/DEMOCHKLST 10//04 DWA
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1
G``" °f DEMOLITION
PERMIT APPLICATION
���I N Go oo Department of Community Development
City of Arlington • 238 N Olympic Ave. •Arlington, WA 98223 • Phone (360)403 3431 • FAX (360)403 3447
THIS APPLICATION MUST BE ACCOMPANIED TWO(2)SETS OF FULLY DIMENISIONED PLOT PLANS AND SITE CLEAN-UP
PLAN, TWO(2) COPIES OF AN ASBESTOS ABATEMENT REPORT COMPLETED BY AN APPROVED AGENCY.
Type of Permit: (check one) ( ) Residential ( )Commercial
Project Address: 6,a p f R8 p I /uE Parcel ID#:
Lot#: Subdivision:
Building Area (Sq Ft) i `f 11 54, l No.of floors: � Number of Buildings:
Owner: C& Q� ! 1 1l �e-,) Phone Number: 3/0 0
Address: Z 3g )V /u 13,14 City: N State: L-J Zip Coder Z2'�
Contact Person: a" Phone Number:
Cell Phone: Fax: E-mail:
Address: 3�YY� City: State: Zip Code:
Scope of Work: l
�vtn p u..� ►�`,�.,e��c�� Grp y,.� 4 ij' `�j..
Contractor: Phone Number:
Address: City: State: Zip Code:
Contractor's License Number: Expiration.
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-
describe p o rty wi be in accordance with the laws, rules and regulations of the Stat of Washington.
Applicants Signature Date
Print Applicants Name
RECENED 0510Q'�)
OW 2 5 2005
CQA Englne�n9 p�ept
Forms/DEMO-1