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Permit D06-280 - King County Housing Authority - Residence Demolition
CITY OF TUKNVILA 4029 S 144 ST D06 -280 Tenant: Name: CITY OF TUKWILA Address 4029 S 144 ST, City of Tu_,wila Parcel No.: 0040000198 Address: 4029 S 144 ST TUKW Suite No: Department of Community Development 6300 Southcenter Boulevard, Suite $100 Tukwila, Washington 98188 Phone: 206-431 -3670 Fax: 206-431-3665 Web site: ci.tukwila.wa. Owner: Name: KING COUNTY HOUSING AUTH Address: 15455 65TH AVE S, TUKWILA WA, 98188 Phone: Contractor: Name: RIVERS EDGE SERVICES INC Address' PO BOX 39, KENT WA 98035 -0039 Phone: (253)872 -8988 Contractor License No: RIVERES0000J doc: IBC - PERMIT DEVELOPMENT PERMIT Contact Person: Name: MIKE CUSICK Address: 6300 SOUTHCENTER BL, STE 100, TUKWILA WA, 98188 Phone: 206 431 -2441 "continued on next page" Steven M. 4et. Mayor Steve Lancaster, Director Permit Number: D06 -280 Issue Date: 08/08/2006 Permit Expires On: 02/04/2007 Expiration Date: 04/14/2007 DESCRIPTION OF WORK: DEMOLITION OF HOUSE. PROPERTY ON VALVUE SEWER AND WATER DISTRICT #125 WATER. PUBLIC WORKS ACTIVITIES INCLUDE EROSION CONTROL. Value of Construction: $19,156.00 Fees Collected: $661.50 Type of Fire Protection: NONE International Building Code Edition: 2003 Type of Construction: VB Occupancy per IBC: 0022 006 -280 Printed: 08 -08 -2006 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N Fire Loop Hydrant: N Number: 0 Size (Inches): 0 Flood Control Zone: N Hauling: N Start Time: End Time: Land Altering: N Volumes: Cut 0 c.y. Fill 0 c.y. Landscape Irrigation: N Moving Oversize Load: N Start Time: End Time: Sanitary Side Sewer: N Sewer Main Extension: N Private: Public: Storm Drainage: N Street Use: N Profit: N Non - Profit: N Water Main Extension: N Private: Public: Water Meter: N Permit Center Authorized Signature: MIA I hereby certify that I have read and his permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating construction or the performance of work. I am authorized to sign and obtain this development permit. Signature: doc: IBC - PERMIT City of Tu.,wila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431 -3670 Fax: 206 -431 -3665 Web site: ci.tukwila.wa.us Ait-h4 6Go Steven M. Asti, Mayor Steve Lancaster, Director Permit Number: D06 -280 Issue Date: 08/08/2006 Permit Expires On: 02/0412007 Date: Cfl io A , GJU 1 Ut.N Date: f) CJ CND Print Name: c I t ce}( c This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. D06 -280 Printed: 08 -08 -2006 CITY OP fl fl' ''! A DEPT. OF CO:.:. .'i' :. I } E:.' / ' - NT 6300 C,I.UfHJ `; J. TUKW'viLH, VIA 6„ i „3 1: ***BUILDING DEPARTMENT CONDITIONS "' PERMIT CONDITIONS 'go/PERMIT CENTER Parcel No.: 0040000198 Permit Number: D06 -280 Address: 4029 S 144 ST TUKW Status: ISSUED Suite No: Applied Date: 07/21/2006 Tenant: CITY OF TUKWILA Issue Date: 08/08/2006 2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the Building Official. 3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to start of any construction. These documents shall be maintained and made available until final inspection approval is granted. 4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of this requirement. 5: All construction noise to be in compliance with Chapter 8.22 of the City of Tukwila Municipal Code. A copy can be obtained at City Hall in the office of the City Clerk. 6: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the Cityof Tukwila Permit Center. 7: All electrical work shall be inspected and approved under a separate permit issued by the Washington State Department of Labor and Industries (206/248 - 6630). 8: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the Building Official from requiring the correction of errors in the construction documents and other data. 9: ***PUBLIC WORKS DEPARTMENT CONDITIONS*** 10: Contractor shall notify Public Works Utility Inspector at (206)433 -0179 of commencement and completion of work at least 24 hours in advance. 11: The applicant must notify the City Utility Inspector at (206)433 -0179 upon commencement and completion of work at least 24 hours in advance. All inspection requests for utility work must also be made 24 hours in advance. 12: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation off -site or into existing drainage facilities. 13: From October 1 through April 30, cover any slopes and stockpiles that are 3H:1 V or steeper and have a vertical rise of 10 feet or more and will be unworked for greater than 12 hours. During this time period, cover or mulch other disturbed areas, if they will be unworked more than 2 days. Covered material must be stockpiled on site at the beginning of this period. Inspect and maintain this stabilization weekly and immediately before, during and following storms. 14: From May 1 through September 30, inspect and maintain temporary erosion prevention and sediment at least monthly. All disturbed areas of the site shall be permanently stabilized prior to final construction approval. doc: Conditions 006 -280 Printed: 08-08 -2006 CITY rr: TINS ' A DEFT. OF CC J;:,iy JT 6300 CLUTHCLN L; :LLVD. TUKWILA, WA 98188 doc: Conditions PERMIT CENTER 15: The site shall have permanent erosion control measures in place as soon as possible after final grading has been completed and prior to the Final Inspection. 16: Any material spilled onto any street shall be cleaned up immediately. 17: Trucks leaving the site shall deposit no material on the street, or inside the City Right of Way. **continued on next page" D06 -280 Printed: 08-08 -2006 C'TY OF TtJV " A DEPT rr c:: . . 6G J L :1 L.::D. TUI.WILA, WA SUtb3 ` PERMIT CENTER I hereby certify that 1 have read these conditions and will comply with them as outlined. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provision of any other work or local laws regulating construction or the performance of work. Signature: «a^ ' -Q( Date: 51 U V Print Name: C f at liner doc: Conditions D06 -280 Printed: 08 -08 -2006 Name: / e Mailing Address: E -Mail Address: Company Name: Mailing Address: E -Mail Address: CITY OF TUKWILA Community Developme( lepartment Public Works DepartmeJl Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 htto://www.ci.tukwila.wa.us Site Address: 4 6 2 C I .s l yN ST Tenant Name: IVA- Property Owners Name: Q trio or 'Tl/1CG/ I LA Mailing Address: C 2 06 So rN -CE,- 're n- n 1 vo. Wit-' /LA r,/.4 `i S I S t State Zip sul re !oz CONTACT PERSON: Ci 3 t Soda, 13LW.. 77/k 6../1 !/1 C✓4 Ivies City State Zip riLPdisrc k @ C/ _ t &g!✓ /[4 - &EA. OS Fax Number: 2C - "AV- 3 C 5' GENERAL CONTRACTOR INFORMATION (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5) ) Company Name: el VEIL S EOLC SHt vie C ! /metes Mailing Address: p d. I301C 3q kh-'T 4,4 State Zip Contact Person: C Q it b uO LP C S Day Telephone: 253 - 192- 111 S a E -Mail Address: /CA r^r2j. e r lve-xse l b r 4 e -Weer Corn Fax Number: 2C3 — ')-Z — �j`I r�i 9 Contractor Registration Number: (11lf1ees b b e d J Expiration Date: 4 P to rl : ARCHITECtOF RECORD - All plans must be wet stamped by Architect of Record , Contact Person: E -Mail Address: ENGINEER OF RECORD — All plans must be wet Stamped by Engineer of Record P»t3Lit o+ck Mailing Address: C 3ce. got," 114 C K3L vv. T7/C 4✓ 1CA lr4 City State Day Telephone: Fax Number: Company Name: C Fria ef Tv le w t LA Contact Person: N t e L a e P. et-n(1 Pe Q:Upplic tiomtpotm,-Appliotiom On LineV- 2006 - Petmit Appliation.doc Revised: 42006 bit Building Per `rNo. Mechanical °P itNt Plumbing /Gas Permit Public `Works 'Permit 1 Project No Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. **Please Print* King Co Assessor's Tax No.: OO'Q OO no 1, Suite Number: Floor: New Tenant: ❑ .... Yes 0 ..No City Day Telephone: 29C— 93/- 2 qt? City 910 3 5 State Zip City Day Telephone: Fax Number: Zip Page 1 of 6 Valuation of Project (contractor's bid price): $_ 1 T C. N� Scope of Work (please provide detailed information): Oe r•o 1. -rlo -.- geabi ( 4029 5 7)3 QUpplicetions\Fotmn- Applications On Line \3 -2606 - Permit Application.doc Revised: 4-2006 bh 19y rH- sines. Existing Building Valuation: $ /Q66 Will there be new rack storage? ❑ ..Yes .. No (If yes, a separate permit and plan submittal will be required) Provide All Building Areas in Square Footagef 1 °F loor 2' Floor 3" Floor Floors Basement Accessory Structure* AttachedOarage Detached Garage Attached Detached Carport Covered Deck Uncovered "Decle Existing I iftfif Interior Remodel Addition to > Xisting lStiucture 'New Type of Construction per ISC Type of Occupancy per PLANNING DIVISION: Single - family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area for accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ ....Yes ❑ ..No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑.. Sprinklers ❑..Automatic Fire Alarm ..None ❑ . Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑..Yes ❑..No If "yes", attach list of materials and storage locations on a separate 8 -1/2 x 11 paper indicating quantities and Material Safety Data Sheets. SEPTIC SYSTEM: On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. Page 2 of 6 Fixture Type: Qty Fixture Type: Qty Fixture Type: Qty Fixture Type: Qty Bathtub or combination bath/shower Drinking fountain or water cooler (per head) Wash fountain Gas piping outlets Bidet Food -waste grinder, commercial Receptor, indirect waste Clothes washer, domestic Floor drain Sinks Dental unit, cuspidor Shower, single head trap Urinals Dishwasher, domestic, with independent drain Lavatory Water Closet Building sewer or trailer park sewer Rain water system — per drain (inside building) Water heater and/or vent Industrial waste pretreatment interceptor, including its trap and vent, except for kitchen type grease interceptors Repair or alteration of water piping and/or water treating equipment Repair or alteration of drainage or vent piping Medical gas piping system serving one to five inlets/outlets for specific gas Additional medical gas inlets/outlets — six or more I` "LUMBING AND GAS PIPING PERMIT INFORMATION -- 206431- 3670 PLUMBING AND GAS PIPING CONTRACTOR INFORMATION Company Name: Mailing Address: State Contact Person: E -Mail Address: Contractor Registration Number: Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quan ity below: Q:%AppllndonsWPoems-Applications On LIneO -2006 - Permit Appliwion.doc Revised: 4-2006 bh City Day Telephone: Fax Number: Expiration Date: Zip Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): Page 5 of 6 Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. Building and Mechanical Permit The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition). Plumbing Permit The Building Official may grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 Uniform Plumbing code (current edition). I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER Signature: Print Name: Mailing Address: (3Ga 5b4.71.1 Cer✓ "— I Date Application Accepted: 6'NT: /11„ / / P d v1 4 r t-. 1 tat Q:UpplicationsWotms- Applications Oe LineV- 2006 - Penult Application.doc Revised: 4-2006 bh Date: 74i la Day Telephone: 2.4-' - 4 1-- .0 997 0 L✓L fl- tc.i1c4 44 /4 lie e s City State Zip Staff Initials: 1, (b&I Page 6 of 6 Date Application Expires: MIAs g— ACCOUNT ITEM LIST: Description Current Pmts City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 0040000198 Address: 4029 S 144 ST TUKW Suite No: Applicant: CITY OF TUKW/LA Receipt No.: R06 -01107 Payment Amount: 661.50 Initials: JEM Payment Date: 07/24/2006 05:16 PM User ID: 1165 Balance: $0.00 Payee: CHARGE TO ACCOUNT 000.20.531.900.49.01 TRANSACTION LIST: Type Method Description Amount Payment Other 661.50 BUILDING - NONRES PLAN CHECK - NONRES STATE BUILDING SURCHARGE RECEIPT Account Code 000/322.100 000/345.830 000/386.904 Permit Number: D06 -280 Status: PENDING Applied Date: 07/21/2006 Issue Date: 398.18 258.82 4.50 Total: 661.50 7769 .2 9716 TOTAL 0.00 doc: Receipt Printed: 07 -24 -2006 Project: ( je 7 2,i ✓/ /1, ,,,,, �n Type of Inspection: h -,v,4/ _ *, required prior to approval. Address: 1 4 /O 7y S; /y`/ Date Called: COMMENTS: Special Instructions: Date Wanted: /— L/_ O4# a.m. Requester: /77 i /lr t /e; Phone No: g. Approved per applicable codes. Corrections required prior to approval. COMMENTS: ( / PPrni;-/ r , /f lr /1 '4 tor: - rots /7 ..,�. I Date: ./Date: INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 006 --2296 43 8.00 REINSPECT! FEE REQSIIRED. Prior to inspection, fee must be paid at 6300 Southce er Blvd, uite 100. Call to sechedule reinspection. Receipt No.: Date: COMMENTS: Type of Inspectio �+ /� -CA-c X Address , 41,52,1 ru / 1 `t /Vol NI 1€6(GtW$T-- IA 444.- A /J°JC ?` a Special Instructions: , JA /ree ft-tc,l_C. f1,4 toem a.m. p.m. Requester; M t - Ck n - goo upet, // 2/67 7c, / 9 O✓ , OM o fl 7)) fl a ita-i a►t /cC GuQcc., /4 Proje t: �' , / 0 I Il..�wrl Cl . Type of Inspectio �+ /� -CA-c X Address , 41,52,1 ru / 1 `t � T I A Date Called: / Special Instructions: Date Wanted: it "/ a.m. p.m. Requester; M t - Ck n - Phone No: k fr je 116 C Put/ Approved per applicable codes. INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 PERMIT NO. Corrections required prior to approval. Inspector: rate: V 0 C $58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. Receipt No.: Date: f I •. I D J U I O iD N � � Y p J ; I: CL ° Z J 1 :t L, vi U !— I a a. <. W I. I m � � s � 3nA3AY U) S1N3YdUYdV 30VINU 01a3A1a .LST b I AVM3AIa0 o w 3003H z AVf 3AIN0 a .(4[?�y7 0 Ici L [ri a te o te z a a b r, ONO: V y a a I � I 101 1lVHdSV . y0-- --- --- ---- i. I (dOHS ONV 301.4,10 SW OM 213V1ii0 ,1) I I I ---------------- - - - - -- I ------ - - - - -- I ' � I CD �p � � N I 1•. 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III�III�I�I�II1�1�1�2II�I.II3II,IIITIIIrI� 41TI1 !IIIIIIIII'I5I�`I�lll���> >��6� Inch 1118 £STCOTT� 4° f t vi fl k� arTttrrtY X y� sincef8n,• 1 F' hii3 { iii l 5I4 bL. E4 Z4. 44 04: ,J �-- Ill. lil�lllllllll�lllIIIIII�IILILI�: LI�LIlIILIII�LIIIIII�II�L1111J111�1' IIIIIIII�IIIIIIIIT�IIIIII�III�IfIIIIIII�IIIIIIIII�IIIIIl111�fllllllll�lllllllll�lilll. ; 2 r6 C 5. 0, d CL mAca Lu :3o ��� 1.8£�� y Cif 1 5 N G U z 0 t0 Z Demolition of the House Located at 4029 South 144 Street Proiect Scope 1 . Provide silt fence along south side of the house. 2. Demolish water and sanitary sewer lines to back of sidewalk. Contractor to cap and plug service lines. Mark stub ends with treated 2" x 4 ". 3. Abate and demolish asbestos per report dated June 8, 2006, prepared by PBS Engineering & Environmental. Contractor obtains all required permits for the removal of the asbestos. 4. The contractor shall demolish the lean -to on the north side of the garage. The garage shall remain in place. 5. Coordinate with private utility company for the capping of their underground service lines to the house. Mark stub ends with treated 2" x 4 °. 6. Cap off and mark location of underground power service to the garage with treated 2" x 4 ". 7. Demolish existing house and foundation. The City of Tukwila will backfill and regrade site. 8. Existing pavement and driveway to remain in place. 9. Demolish front steps and concrete walk to back of sidewalk. 10. There may be a buried oil tank on the east side of the house. It is the scope of project for the contractor to remove the tank and dispose of the tank and any remaining fuel oil. 11. Existing fences are to remain in place. C OM PPLIAANCE ft non nvw0 AUG 0 3 2006 RECEIVED CITY OF TUKWLJ1 JUL 2 1 2006 0fjr Of Tukwila BUILDING DIVISION Pe FILE No. CDpr PERMrrcENTER bo -no Print Map Page King County Home• „ :f. Ner /9 :Services', Parcel Map and Data _ 7 s230,ISe 1 9 S f l ri k j .7551200020 73230/9208 7523049782 J N , 3312000 • t J 1311200073 ui ,7523049088 . > f 4 152304909 2 Fa- 13512 �, 7323049073 N r - _ Y ,63120000F 7 2 . . J o S144T sr 0040000198 y y OOOO f91 0040000148 0040000145 0040000191 ....................... ......_ _.......... . {h ng C1 H0000235' 0640000240 Parcel Number Address Zipcode Taxpayer 0040000198 4029 S 144TH ST KING CO HOUSING AUTHORITY The information included on this map has been compiled by King County staff from a variety of sources and is subject to change without notice. King County makes no representations or warranties, express or implied, as to accuracy, completeness. timeliness, or rights to the use of such Information. King County shall not be liable for any general, special, Indirect, incidental, or consequential damages including, but not limited to, lost revenues or lost profits resulting from the use or misuse of the Information contained on this map. Any sale of this map or information on this map is prohibited except by written permission of King County.” King County I GIS Center I News I Services I Comments Search By visiting this and other King County web pages, you expressly agree to be bound by terms and conditions of the site. The details. httn.// www5 .metrokc.cov /narcelviewer/Print Process.asp Search 't; Page 1 of 6/8/2 Parcel Name Site Address Ceo Area Block Legal Description 004000-0198 KING CO HOUSING AUTHORITY 50 -20 2 Parcel 004000 -0198 KING CO HOUSING AUTHORITY Parcel Data ADAMS HOME TRS LESS W 29.5 FT LESS S 11.5 FT & LESS E 3 FT THOF Land Data Land SqFt 28,943 Use Exemption Acres 0.66 Environmental No Water WATER DISTRICT Topography No Sewer /Septic PUBLIC Traffic No Views Rainier No Sound No Olympics No Lk Wash No Cascades No Lk Samm No Territorial No Lk/Riv /Crk No Seattle No Other No Waterfront Location No Footage 0 Bank No Access Rights No Tide/Shore No Prox. Influence No Restricted No Poor Quality No Page 1 of 3 Present Use Single Family(C/I Zone) Zoning HDR Jurisdiction TUKWILA Property Type Code C Lot 15 Tax Yr Omi Y 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 Number Exempt No Bldg No Exmpt Tax 289,400 Exmpt Tax 289,400 Exmpt Tax 289,400 Exmpt Tax 289,400 Exmpt Tax 289,400 Exmpt Tax 289,400 Exmpt Tax 289,400 Exmpt Tax 101,000 Parcel 004000 -0198 ICING CO HOUSING AUTHORITY Tax Roll History Appraised Taxable TaxValue Land Val Imp Val Total Land Val Imp Val Total Reason 1,000 290,400 1,000 290,400 1,000 290,400 1,000 290,400 1,000 290,400 1,000 290,400 1,000 290,400 72,000 173,000 Sales History E Number Sale Date Sale Price Instrument Sale Reason 1891662 5/7/2001 Statutory Warranty Deed Other Review History Tax Yr Review# Review Type Appeal Val Hearing Dt Settlement Val Hearing Result Status Permit History Type Value Issue Date Jurisdiction Review Dt Home Improvement Exemption Date Rec Date Comp Beg Yr Est Cost Page 2 of 3 101,00 102,30 101,30 101,30 87,40 87,40 66,40 66,40 72,00 173,00 62,50 163,80 62,50 163,80 62,50 163,80 52,60 140,00 52,60 140,00 36,50 102,90 36,50 102,90 License Information License RIVERES0000J Licensee Name RIVERS EDGE SERVICES INC Licensee Type CONSTRUCTION CONTRACTOR UBI 601993602 Ind. Ins. Account Id Business Type CORPORATION Address 1 PO BOX 39 Address 2 City KENT County KING State WA Zip 980350039 Phone 2538728988 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 3/7/2001 Expiration Date 4/14/2007 Suspend Date Separation Date Parent Company Previous License RIVERES0110P Next License RIVEREV981DE Associated License Business Owner Information Name Role Effective Date Expiration Date KEMP, PAUL W PRESIDENT 02/07/2001 book Up a Contractor, Electrician or Plumber License Detail Washington State Department of Labor and Industries General/Specialty Contractor A business registered as a construction contractor with L &I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Page 1 of 3 https: // fortress .wa.gov /lni/bbip /printer.aspx ?License= RIVERES0000J 07/08/2006 Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 06203570 AMERICAN SAFETY INDEMNITY CO ENOVI129130601 04/01/2006 04/01/2007 01/27/2006 $8,650.20 $2,000,000.00 03/30/2006 #3 AMERICAN SAFETY INDEMNITY CO HSR058128001 04/01/2005 04/01/2006 $7,779.51 $2,000,000.00 03/30/2005 #2 EVEREST INDEMNITY INS CO 2200 04/01/2004 04/01 /2005 $1,000,000.00 04 /02/2004 #1 GREAT AMERICAN WEST PAC1322569 04/01 /2000 Until Cancelled 03/07/2001 Summons / Complaints Information Summons / Complaint Cause Number Tax Warrant Id Plaintiff County Dismissal Date Complaint Date Complaint Amount #2 06203570 FIRST NATIONAL INS CO OF AM RHINE EQUIPT CO ICING 03/27/2006 01/27/2006 $8,650.20 #1 022062356 #1 BUD'S HAULING /LEASING INC PIERCE 04/21/2006 04/16/2002 $7,779.51 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date #2 FIRST NATIONAL INS CO OF AM 6097044 09/10/2001 Until Cancelled $12,000.00 08/30/2001 #1 TRAVELERS CAS & SURETY CO 0815103351195 09/10/2000 09/10/2001 $6,000.00 09/11/2000 Look Up a Contractor, Electrician or Plumber License Detail Savings Information No Matching Information Judgement Information Tax Page 2 of 3 https: // fortress. wa. gov /lni/bbip /printer.aspx ?License= RIVERES0000J 07/08/2006 # Cause Number Warrant Id Plaintiff County Judgement Date Judgement Amount Payment Date Payment Amount Paid By #2 06203570 RHINE EQUIPT CO KING $0.00 $0.00 #1 022062356 BUD'S HAULING /LEASING INC PIERCE $0.00 $0.00 Look Up a Contractor, Electrician or Plumber License Detail Page 3 of 3 https: // fortress. wa. gov /Ini/bbip /printer.aspx ?License= RIVERES0000J 07/08/2006 PBS Prepared for: PI- FILE COPS Permit No. Asbestos - Containing Materials and Lead Paint Summary of Findings 4029 South 144th Street — Project Site Tukwila, Washington 98168 City of Tukwila Public Works Department 6300 Southcenter Boulevard Tukwila, Washington 98188 June 2006 PBS Project #: 40407.007 Dog- a C77 c-:i c.- Ssslont ze CODE I COMP FOR CE snoonvco AUO 0 3 2005 Ci Of Tukw� jia BUILDING DMSION RECEIVED crry TUOF KWILA JUL 2 1 2006 PERMIT CENTER 130 Nickerson Street Suite 107 Seattle. WA 98109 206.233.9639 "we 206.762.4780 rex ENGINEERING AND ENVIRONMENTAL cinb www.pbs.nv.com • PBS June 8, 2006 Mr. Michael Cusick City of Tukwila Public Works Department 6300 Southcenter Boulevard Tukwila, WA 98188 RE: 4029 South 144th Street Asbestos - Containing Materials and Lead Paint Survey PBS Project No. 40407.007 Dear Mr. Cusick: PBS Engineering and Environmental (PBS) performed an inspection of the former residence and detached garage located at 4029 South 144th Street in Tukwila, Washington for the presence of asbestos - containing materials (ACMs) and lead - containing paint (LCP). According to your information, this project is in conjunction with a proposed demolition of the site structures. The former residence is a one -story building with a basement that contains a total of 1,444 square feet. The residence was constructed in 1938, and the detached garage was built in 1978. The residence has been vacant since 2001. Interior finishes consist of gypsum wallboard walls and ceilings, sheet vinyl flooring, floor tiles, hardwood floors, and a concrete floor in the basement. The roof had three layers of asphalt composition shingles over asphalt roofing paper. Asbestos - Containing Materials (ACM) The intent of this letter is to ensure that the City of Tukwila Public Works Department is in compliance with the Puget Sound Clean Air Agency and Washington State Department of Labor and Industries' requirement that a "good faith" inspection for ACM be performed prior to renovation or demolition activities. While PBS has endeavored to identify all ACM, unidentified ACM may exist in concealed or inaccessible locations. Inaccessible areas are defined as those requiring selective demolition, fall protection or confined -space entry protocols to gain access. PBS recommends that concealed components and materials be sampled for asbestos prior to impact. Suspect materials were sampled by AHERA- accredited Inspector, Harry Goren (Certification #1018422, exp. 11/2/06). Samples were assigned unique identification numbers and delivered to NVL under chain -of- custody protocols. Samples were analyzed according to EPA Method 600R- 93/116 using Polarized Light Microscopy (PLM), which has a reliable limit of quantification of 1% asbestos by volume. PORTLAND SEATTLE VANCOUVER EUGENE BEND TRI-CITIES 130 Nickerson Street Suite 107 Seattle, WA 98109 206.233.9639 MAIN 206.762.4780 FM ENGINEERING AND ENVIRONMENTAL www.pbsenv.com 4029 South 144th Street, Tukwila, WA Asbestos - Containing Materials and Lead Paint Survey June 8, 2006 Page 2 of 3 The attached bulk sample chain -of- custody forms identify all suspect materials that were sampled by PBS and analyzed for asbestos. The following materials were found to contain asbestos during PBS's survey: • Sheet vinyl flooring (felt backing only) and mastic — Kitchen, hallways, NE bedroom, SW bathroom, SW bedroom. • 9 -inch floor tile and mastic (SW bathroom under sink, basement family room) • 12 -inch floor tile (Garage workshop) • Silver light fixture lining (SE bedroom). May be found in similar fixtures. ■ Duct wrap felt (white) in basement found on rectangular ductwork. Localized to one area. • *Joint compound on gypsum wallboard system (SW bedroom). Less than 1% asbestos content by composite. * A composite of the gypsum wallboard and the joint compound tested less than 1% asbestos and may be treated as a non - asbestos - containing material. Although the material is not considered an asbestos - containing material, contractors performing renovation work should be notified of the presence of asbestos in the joint compound. Workers are required to have 2 hours of asbestos awareness training, initial air monitoring, worker and environmental protection, and engineering controls (wet methods and HEPA vacuums). The following materials were not found to contain asbestos via sampling by PBS: ■ Sheet flooring and mastic (Living room under carpet, bathroom, east bedroom, rear SE bedroom • Ceramic tile mastic (bathroom) • Gypsum wallboard and joint compound (Living room, east bedroom) • 9 -inch floor tiles and mastic (Rear SE bedroom) • Insulation with fine particle dust below insulation (attic) • Roofing paper and all layers of asphalt composition shingles The ACM identified above should be removed by properly trained personnel using appropriate protection, work practices and engineering controls prior to impact by demolition or renovation. A qualified asbestos abatement contractor licensed in the State of Washington should be employed to remove all such ACM according to applicable local, state and federal regulations. Caution should be exercised during renovations, as concealed ACM may exist in various locations. Any material not previously identified in this survey encountered during renovations should be sampled to determine asbestos content prior to impact. 4029 South 144th Street, Tukwila, WA Asbestos - Containing Materials and Lead Paint Survey June 8, 2006 Page 3 of 3 Lead - Containing Paint (LCP) Representative painted coatings were sampled and analyzed to determine lead content. Pint samples were analyzed by Flame Atomic Absorption for total lead content to determine the extent of LCP in the substrate. Six (6) paint chip samples were collected from representative substrates and analyzed. Lead was detected in concentrations above the analytical limit of detection in all of the paint chips samples analyzed. The following building components contain lead paint coatings. • Light yellow semi -gloss paint in the living room ■ Tan over rose paint in the E bedroom ■ Tan over green paint in the SE bedroom • White paint on the fascia board exterior trim • Dark brown on the cedar siding exterior The lead concentrations range from 0.0530% to 6.0 %. The painted coatings are in poor condition and delaminating from the respective substrates. Based on the sample results of representative coatings, it may be assumed that all coatings on building materials within the project site contain lead. See attached laboratory analysis report. The presence of lead in painted coatings ,requires construction work to be performed in compliance with State and Federal regulations. Employers of personnel impacting lead - containing paint and coatings are required to perform a negative exposure assessment and provide proper training, respiratory protection and medical surveillance as outlined in WAC 296 -155. Respectfully, Harry Goren Project Manager Attachments: Representative Photographs of Site Conditions PLM Laboratory Reports and Chain -of- Custody Lead paint Laboratory Reports and Chain -of- Custody i•1 �ii.r�`` x 4029 S. 144th Street PLM ASBESTOS SAMPLE INVENTORY PBS SAMPLE # MATERIAL TYPE 40407.007 -001 Sheet Flooring Brown/Tan Mastic 40407.007 -002 Gypsum Wallboard Joint Compound 40407.007 -003 Sheet Flooring (2 Layers) Green over red bottom layer 40407.007 -004 Sheet Flooring (2 Layers) Green Kitchen over red bottom layer 40407.007 -005 Sheet Flooring (2 Layers) Green Hall over red bottom layer 40407.007 -006 40407.007 -007 40407.007 -011 5/24/2006 Sheet Flooring Ivory Mastic Ceramic Tile Mastic 40407.007 -008 Sheet Floor Green/Pink 40407.007 -009 Sheet Floor Green/Pink 40407.007 -010 Sheet Flooring Tan Gypsum Wallboard Joint Compound j.00ATION Living Room Living Room Dining Room Bathroom Bathroom Northeast Bedroom Hall East Bedroom East Bedroom LAB DESCRIPTION Layer 1: Tan linoleum Layer 2: Black asphaltic fibrous backing with brown mastic Layer 1: Off -white compacted powdery material with paint Layer 2: Off-white compacted powdery material with paint and Layer 3: Off -white chalky material Layer 1: Tan sheet vinyl Layer 2: Light gray fibrous backing with gold mastic Layer 3: Tan linoluem Layer 4: Black asphaltic fibrous backing with brown mastic Layer 1: Tan sheet vinyl Layer 2: Light gray fibrous backing with gold mastic Layer 3: Black asphaltic fibrous backing with brown mastic Layer 4: Tan linoleum Layer 4: Black asphaltic fibrous backing with brown mastic Layer 1: Tan sheet vinyl Layer 2: Light gray fibrous backing with gold mastic Layer 3: Tan linoleum Layer 4: Black asphaltic fibrous backing with brown mastic Layer 1: Tan sheet vinyl Layer 2: Light gray fibrous backing with gold mastic Layer 1: Tan brittle mastic Layer 2: Off -white chalky material with paper Layer 1: Light gray sheet vinyl Layer 2: Light gray fibrous backing with gold mastic Layer 1: Brown sheet vinyl Layer 2: Light gray fibrous backing with gold mastic layer 1: Tan thin sheet vinyl Layer 2: Black asphaltic fibrous backing with mastic Layer 1: Off -white chalky material with paper NAD = No Asbestos Detected PBS Engineering and Environmental PBS Project #40407.007 LAB RESULT NAD NAD NAD NAD NAD NAD 45% Chrysotile NAD NAD NAD 45% Chrysotile NAD NAG NAD NAD 45% Chrysotile NAD NAD NAD NAD NAD NAD NAG 45% Chrysotile NAD 45% Chrysotile NAD NAD NAG 1 of 2 4029 S. 144th Street PLM ASBESTOS SAMPLE INVENTORY PBS SAMPLE # MATERIAL TYPE 40407.007 -012 Light Fixture Lining 40407.007 -013 40407.007 -017 40407.007 -018 40407.007 -019 40407.007 -021 40407.007 -022 40407.007 -023 40407.007 -024 40407.007 -025 40407.007 -026 40407.007 -027 Sheet Flooring Gray 40407.007 -014 9" Floor Tiles 40407.007 -015 Sheet Flooring Brown Pebble 40407.007 -016 Sheet Flooring Light Tan Gypsum Wallboard Joint Compound 9' Floor Tile Mastic 9' Floor Tile Dark Brown 40407.007 -020 9' Floor Tile Light Brown Duct Tape Insulation w/Panicles Roofing Paper Asphalt Shingle Asphalt Shingle Asphalt Shingle 12" Floor Tile Tan LOCATION Southeast Bedroom Rear Southeast Bedroom Rear Southeast Bedroom Southwest Bathroom Southwest Bedroom Southwest Bedroom Southwest Bathroom under Layer 1: BrownAan tile Layer 2: Black asphaltic mastic Family Room Basement Layer 1: Brown tile Layer 2: Black asphaltic mastic Family Room Basement Ductwork Basement Attic Roof Bottom Layer Roof Middle Layer Roof Top Layer Root Garage - Shop LAB DESCRIPTION Layer 1: Tan fibrous material with foil Layer 1: Tan thin sheet vinyl Layer 2: Black asphaltic fibrous backing with mastic Layer 1: Brown flooring material Layer 2: Black asphaltic fibrous backing with mastic Layer 1: Tan sheet vinyl Layer 2: Light gray fibrous backing with gold mastic Layer 3: Ott -white chalky material Layer 1: Tan sheet vinyl with pattern Layer 2: Light gray fibrous backing with gold mastic Layer. 1: Off-white compacted powdery material with paint Layer 2: Off -white compacted powdery material with paper Layer 1: Tan the Layer 2: Black asphaltic mastic Layer 3: Gray brittle material Layer 1: Light gray fibrous material with silver paint Layer 1: Tan fibrous material Layer 1: Black asphaltic fibrous material Layer 1: Black asphaltic fibrous material with granules Layer 1: Black asphaltic fibrous material with granules Layer 1: Black asphaltic fibrous material with granules Layer 1: Beige tile Layer 2: Yellow brittle mastic PBS Engineering and Environmental PBS Protect #40407.007 LAB RESULT 75% Chrysotile NAD NAD NAD NAD NAD 45% Chrysotile NAD NAD 45% Chrysotile 2% Chrysolite 2% Chrysolite (Composite =c1 %) 2% Chrysotile 2% Chrysotile 3% Chrysotile 2% Chrysotile 4% Chrysolite 2% Chrysotile NAD 60% Chrysotile NAD NAD WAD NAD NAD 2% Chrysotile NAD NAD = No Asbestos Detected 5/24/2006 2 of 2 • NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 S 144th St. . .._. Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Lab ID: 26040519 Client Sample #: 40407.007 - 01 Location: 4029 S 144th St. Layer 1 of 2 Description: Tan linoleum Non - Fibrous Materials: Other Fibrous Materials:% Linoleum /binder Cellulose 40% Layer 2 of 2 Description: Black asphaltic fibrous backing with brown mastic Layer 1 of 3 Layer 2 of 3 Layer 3 of 3 Non - Fibrous Materials: Asphalt/binder, Mastic/binder Lab ID: 26040520 Client Sample #: 40407.007 - 02 Location: 4029 S 144th St. Description: Off -white compacted powdery material with paint Non - Fibrous Materials: Calcareous binder, Paint Other Fibrous Materials:% Cellulose 60% Synthetic fibers 3% Other Fibrous Materials:% None Detected ND Description: Off -white compacted powdery material with paint and paper Non - Fibrous Materials: Other Fibrous Materials:% Binder /Filler, Paint Cellulose 40% Description: Off -white chalky material with paper Non - Fibrous Materials: Other Fibrous Materials:% Fine particles, Gypsum/binder Cellulose 12% #102063 Batch #: 2606590.00 Client Project #: 40407.007 Samples Received: 15 Samples Analyzed: 15 Method: EPA/600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Lab ID: 26040521 Client Sample #: 40407.007 -03 Location: 4029 S 144th St Layer 1 of 4 Description: Tan sheet vinyl Non - Fibrous Materials: Other Fibrous Materials:% Asbestos Type: % Vinyl/binder None Detected ND None Detected ND Sampled by: Client Analyzed by: Lyudmila Manzar Reviewed by: Munaf Khan Date: 05/19/2006 Date: 05/19/2006 Munaf Khan, Laboratory Director • Note: It samples are not homogeneous, then subsampies of the components were analyzed separately. All bulk samples are analyzed using EPA 600 /R - 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0.3 %, 5 °% =1 -9 %, 10%= 5.15 %, 20% =10.30 %, 50%=40 40 %). This report relates only to the Items tested. If sample was not collected by NVL personnel, then the accuracy of the results Is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except In full, without written approval of NVL Laboratories, Inc It shall not be used to claim product endorsement by NVIAP or any other agency of the US Government. Page 1 of 6 • f NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location; 4029 S 144th St. Layer 2 of 4 Layer 3 of 4 Layer 4 of 4 Description: Description: Description: Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Light gray fibrous backing with gold mastic Non - Fibrous Materials: Other Fibrous Materials:% Cellulose 15% Binder /Filler, Mastic/binder Tan linoleum Non - Fibrous Materials: Other Fibrous Materials:% Linoleum/binder Cellulose 40% Black asphaltic fibrous backing with brown mastic Non - Fibrous Materials: Asphalt/binder, Mastic/binder Other Fibrous Materials:% Cellulose 60% Synthetic fibers 3% Lab ID: 26040522 Client Sample #: 40407.007 -04 Location: 4029 S 144th St Layer 1 of 5 Description: Tan sheet vinyl Non - Fibrous Materials: Other Fibrous Materials:% VinyVbinder None Detected ND Layer 2 of 5 Description: Light gray fibrous backing with gold mastic Non - Fibrous Materials: Other Fibrous Materials% Binder /Filler, Mastic/binder Cellulose 15% Layer 3 of 5 Description: Black asphaltic fibrous backing with brown mastic Non - Fibrous Materials: Other Fibrous Materials :% Asphalt/binder Cellulose 80% Layer 4 of 5 Description: Tan linoleum Non - Fibrous Materials: Other Fibrous Materials:% Linoleum/binder Cellulose 40% Layer 5 of 5 Description: Black asphaltic fibrous backing with brown mastic Non - Fibrous Materials: Other Fibrous Materials:% Asphalt/binder, Mastic/binder Cellulose 60% EngM l' a p #102063 Batch #: 2606590.00 Client Project #: 40407.007 Samples Received: 15 Samples Analyzed: 15 Method: EPA/600R- 93/116 Asbestos Type: % Chrysotile 45% Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: None Detected ND Asbestos Type: % Chrysotile 45% Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Sampled by: Client Analyzed by: Lyudmila Manzar Reviewed by: Munaf Khan Date: 05/19/2006 / w - n ■ Date: 05/192006 Munaf Khan, Laboratory Director Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. AM bulk samples are analyzed using EPA 600 /R -93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0.3 %, 5 % =1 -9 %, 10 %= 5.15 %, 20 °%= 1030 %, 50 %=10 -60%). This report relates only to the Items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Govemment. Page 2 of 6 NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.834.1936 www.nv1labs.com Client PBS Environmental (Seattle) Address' 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 S 144th St. Lab ID: 26040523 Client Sample #: 40407.007 - 05 Location: 4029 S 144th St Layer 1 of 4 Description: Tan sheet vinyl Non - Fibrous Materials: VinyVbinder Layer 2 of 4 Description: Light gray fibrous backing with gold Non - Fibrous Materials: Binder /Filler, Mastic/binder Layer 3 of 4 Description: Tan linoleum Non - Fibrous Materials: Linoleum /binder Layer 4 of 4 Description: Black asphaltic fibrous backing with Non - Fibrous Materials: Asphalt/binder, Mastic/binder Lab ID: 26040524 Client Sample #: 40407.007 - 06 Location: 4029 S 144th St. Layer 1 of 2 Description: Tan sheet vinyl Non - Fibrous Materials: Vinyl/binder Layer 2 of 2 Description: Light gray fibrous backing with gold mastic Non - Fibrous Materials: Binder /Filler, Mastic/binder Lab ID: 26040525 Client Sample #: 40407.007 - 07 Location: 4029 S 144th St Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Synthetic fibers 3% Other Fibrous Materials:% None Detected ND mastic Other Fibrous Materials:% Cellulose 15% Other Fibrous Materials:% Cellulose 40% brown mastic Other Fibrous Materials:% Cellulose 60% Synthetic fibers 3% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 60% Glass fibers 3% #102083 Batch #: 2606590.00 Client Project #: 40407.007 Samples Received. 15 Samples Analyzed: 15 Method: EPA/600R- 93/116 Asbestos Type: None Detected ND Asbestos Type: % Chrysotile 45% Asbestos Type: None Detected ND Asbestos Type: None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Sampled by: Client Analyzed by: Lyudmila Manzar Reviewed by: Munaf Khan Date: 05/19/2006 Date: 05/19/2006 Munaf Khan, Laboratory Director Note: h samples we not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600/R - 93/118 Method with the following measurement uncertainties for the reported % Asbestos (1 %=0 -3 %, 5% =1 -9 %, 10 %= 5.15 %, 20 %= 10-30 %, 50 %=40 - 60 %). This report relates only to the Items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except M full, whhout written approval of NVL Laboratories, Inc. It shall not be used to dalm product endorsement by NVLAP or any other agency of the US Government Page 3of6 • NVL Laboratories, Inc. 1 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.834.1938 www.nvllabs,com D ulk Asbestos Fibers Analysis #102063 i Client PBS Environmental (Seattle) Address' 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 S 144th St. ... Layer 1 of 2 Layer 2 of 2 Lab ID: 26040526 Client Sample #: 40407.007 -08 Location: 4029 S 144th St Layer 1 of 2 Layer 2 of 2 Lab ID: 26040527 Client Sample #: 40407.007 -09 Location: 4029 S 144th St Layer 1 of 2 Layer 2 of 2 Description: Tan brittle mastic Non - Fibrous Materials: Mastic/binder Description: Off -white chalky material with paper Non - Fibrous Materials: Fine particles, Gypsum/binder Description: Light gray sheet vinyl Non - Fibrous Materials: Vinyl/binder Description: Light gray fibrous backing with gold mastic Non - Fibrous Materials: Binder /Filler, Mastic/binder Description: Brown sheet vinyl Non - Fibrous Materials: Vinyl/binder Description: Light gray fibrous backing with gold Non - Fibrous Materials: Binder /Filler, Mastic/binder Lab ID: 26040528 Client Sample #: 40407.007 -10 Location: 4029 S 144th St. Layer 1 of 2 Description: Tan thin sheet vinyl Non- Fibrous Materials: Vinyl/binder By Polarized Light Microscopy Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 30% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 15% Other Fibrous Materials:% None Detected ND mastic Other Fibrous Materials:% Cellulose 15% Other Fibrous Materials:% None Detected ND Batch #: 2606590.00 Client Project #: 40407.007 Samples Received: 15 Samples Analyzed: 15 Method: EPA/600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % Chrysotile 45% Asbestos Type: % None Detected ND Asbestos Type: % Chrysotile 45% Asbestos Type: % None Detected ND Sampled by: Client y /� Analyzed by: Lyudmila Manzar Date: 05/19/2006 v` \wws. Reviewed by: Munaf Khan Date: 05/19/2006 Munaf Khan, Laboratory Director • Note: If samples are not homogeneous, then subsampies of the components were analyzed separately. AS bulk samples are analyzed using EPA 600/R -93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 %4-3 %, 5% =141 %, 10 %=5.15 %, 20 %= 10-30%, 50 %=40 40%). This report relates only to the Items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in fug, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government Page 4 of 6 NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029.5 144th St. Layer 2 of 2 Lab ID: 26040530 Client Sample #: 40407.007 - 12 Location: 4029 S 144th St. Layer 1 of 1 Layer 1 of 2 Description: Tan fibrous material witltfoil Non- Fibrous Materials: Binder /Filler, Metal foil Lab ID: 26040532 Client Sample #: 40407.007 - 14 Location: 4029 S 144th St. Description: Brown flooring material Non - Fibrous Materials: Cork Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Description: Black asphaltic fibrous backing with mastic Non - Fibrous Materials: Other Fibrous Materials:% Asphalt/binder, Mastic/binder Cellulose 60% Lab ID: 26040529 Client Sample #: 40407.007 - 11 Location: 4029 S 144th St. Layer 1 of 1 Description: Off -white chalky material with paper Non - Fibrous Materials: Other Fibrous Materials:% Fine particles, Gypsum/binder, Paint Cellulose 12% Other Fibrous Materials:% Glass fibers 5% Lab ID: 26040531 Client Sample #: 40407.007 - 13 Location: 4029 S 144th St Layer 1 of 2 Description: Tan thin sheet vinyl Non - Fibrous Materials: Other Fibrous Materials:% Vinyl/binder None Detected ND Layer 2 of 2 Description: Black asphaltic fibrous backing with mastic Non - Fibrous Materials: Other Fibrous Materials:% Asphalt/binder, Mastic/binder Cellulose 60% Other Fibrous Materials:% None Detected ND #102063 Batch #: 2606590.00 Client Project #: 40407.007 Samples Received: 15 Samples Analyzed: 15 Method: EPA/600R- 931116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: To Chrysotile 75% Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Sampled by: Client Analyzed by: Lyudmila Manzar Reviewed by: Munaf Khan Date: 05/19/2006 Date: 05/19/2006 Munaf Khan, Lab . ratory Director Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600/R - 93/116 Method with the following measurement uncertainties for the reported % Asbestos (196 •0-3 %, 6% =1-9 %, 10 % =5 - 15 %, 20 %= 10 50%=40 40%). This report relates only to the Items tested. If sample was not collected by NVL personnel, then the accuracy of the results Is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except In full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. Page 5 of 6 f NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren P . ect Location: 4029 S 144th St. Layer 2 of 2 Description: Black asphaltic fibrous backing with mastic Non - Fibrous Materials: Other Fibrous Materials:% Asphalt/binder, Mastic/binder Cellulose 60% Lab ID: 26040533 Client Sample #: 40407.007 -15 Location: 4029 S 144th St. Layer 1 of 3 Description: Tan sheet vinyl Non - Fibrous Materials: Other Fibrous Materials:% Vinyl/binder None Detected ND Layer 2 of 3 Description: Light gray fibrous backing with gold mastic Layer 3 of 3 Non - Fibrous Materials: Binder /Filler, Mastic/binder Description: Off -white chalky material Non - Fibrous Materials: Fine particles, Gypsum/binder Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Other Fibrous Materials:% Cellulose 15% Other Fibrous Materials:% Cellulose 4% rl „lap #102063 Batch #: 2606590.00 Client Project #: 40407.007 Samples Received: 15 Samples Analyzed: 15 Method: EPA/600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % Chrysotile 45% Asbestos Type: % None Detected ND Sampled by: Client Analyzed by: Lyudmila Manzar Reviewed by: Munaf Khan Date: 05/19/2006 A Date: 05/19/2006 Munaf Khan, Laboratory Director i Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600/R -93/116 Method with the Mowing measurement uncertainties for the reported % Asbestos (1 14•0.3 %, 5 % =1-g %, 10%=5 -15 %, 20%410 -30 %, 50%M0 40 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except In full, without written approval of NVL Laboratories, Inc. It shall not be used to Balm product endorsement by NVLAP or any other agency of the US Government. Page 6 of 6 I NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 baulk ulk Asbestos Fibers Analysis #102063 Client PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 S 144th St. Lab ID: 26040534 Client Sample #: 40407.007 -16 Location: 4029 S 144th St. Layer 1 of 2 Description: Tan sheet vinyl with pattern Non - Fibrous Materials: Layer 2 of 2 Other Fibrous Materials:% Calcareous particles, VinyVbinder None Detected ND Description: Light gray fibrous backing with gold mastic Non- Fibrous Materials: Other Fibrous Materials:% Fine particles, Binder /Filler, Mastic/binder Cellulose 15% Lab ID: 26040535 Client Sample #: 40407.007 -17 Location: 4029 S 144th St. Comments: Composite result for whole sample Is less than 1% asbestos Layer 1 of 3 Layer 2 of 3 Layer 3 of 3 Description: Off -white compacted powdery material with paint Non - Fibrous Materials: Other Fibrous Materials:% Calcareous particles, Binder /Filler, Paint None Detected ND Description: Off -white compacted powdery material with paper Non - Fibrous Materials: Other Fibrous Materials:% Calcareous particles, Binder/Filler Cellulose 45% Description: Off -white chalky material with paper Non - Fibrous Materials: Other Fibrous Materials:% Fine particles, Gypsum/binder Cellulose 20% Lab ID: 26040536 Client Sample #: 40407.007 -18 Location: 4029 S 144th St Layer 1 of 2 Description: Brown/ tan tile Non - Fibrous Materials: VinyVbinder By Polarized Light Microscopy Other Fibrous Materlals:% None Detected ND Batch #: 2606591.00 Client Project #: 40407.007 Samples Received: 12 Samples Analyzed: 12 Method: EPA/800R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % Chrysotile 45% Asbestos Type: % Chrysotile 2% Asbestos Type: % Chrysotile 2% Asbestos Type: % None Detected ND Asbestos Type: % Chrysotile 2% Sampled by: Client Analyzed by: Nadia Prysyazhnyuk Reviewed by: Nick Ly P Date: 05/19/2006 ' %l_i✓ Date: 05/19/2006 Nick Ly,=- �r1.427 t•7� 1 Note: If samples are not homogeneous, then subsamples of the components wars analyzed separately. Alt bulk samples are analyzed using EPA 1300/R -931116 Method with the following measurement uncertainties for the reported % Asbestos (1 %•O - %, 596 - - %. 10 % - 6 %, 20%•10 - 90%, 50%=40 40%). This report relates only to the Items tested. If sample was not collected by NVL personnel, then the accuracy or the results IS limited by the methodology and acuity of the sample collector. This report shall not be reproduced except In M, without written approval of NVL Laboratories, Ina It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government Page 1 of 4 f NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.541.0100, Fax: 206.634.1936 www.nvllabs.com Bulk Asbestos Fibers Analysis Client PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 5 144th St. Layer 2 of 2 Description: Black asphaltic mastic Non - Fibrous Materials: Asphalt/binder, Mastic/binder Lab ID: 28040537 Client Sample #: 40407.007 - 19 Location: 4029 S 144th St. Layer 1 of 2 Description: Brown tile Non- Fibrous Materials: Vinyl/binder Layer 2 of 2 Description: Black asphaltic mastic Non - Fibrous Materials: Asphalt/binder, Mastic/binder Lab ID: 26040538 Client Sample #: 40407.007 - 20 Location: 4029 S 144th St. Layer 1 of 3 Layer 2 of 3 Layer 3 of 3 Description: Tan tile Non - Fibrous Materials: Vinyl/binder Description: Black asphaltic mastic Non - Fibrous Materials: Asphalt/binder, Mastic/binder Description: Gray brittle material Non - Fibrous Materials: Fine particles, Binder/Filler, Mineral grains By Polarized Light Microscopy Other Fibrous Materials:% Cellulose 1% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% None Detected ND Lab ID: 26040539 Client Sample #: 40407.007 -21 Location: 4029 S 144th St. Layer 1 of 1 Description: Light gray fibrous material with silver paint and yellow mastic Non - Fibrous Materials: Other Fibrous Materials:% Fine particles, Binder/Filler, Mastic/binder Cellulose 20% 5t8V(184., #102063 Batch #: 2606591.00 Client Project #: 40407.007 Samples Received: 12 Samples Analyzed: 12 Method: EPA/600R- 93/116 Asbestos Type: % Chrysotile 2% Asbestos Type: % Chrysotile 3% Asbestos Type: % Chrysotile 2% Asbestos Type: % Chrysotile 4% Other Fibrous Materials:% Asbestos Type: % • None Detected ND Chrysotile 2% Other Fibrous Materials:% Asbestos Type: % None Detected ND None Detected ND Asbestos Type: % Chrysotile 60% Sampled by: Client Analyzed by: Nadia Prysyazhnyuk Reviewed by: Nick Ly Date: 05/19/2008 Date: 05/19/2006 � Nick =_a r Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. AU buk samples are analyzed using EPA 60018 -93(116 Method with the following measurement uncertafnuss for the reported %Asbestos (1%=0.3 %, 5% -1-9%, 109(1- 5-10 %, 20 %- i0-30 %. 503640 '.80%). This report relates only to the Items tested. If sample was not collected by NVL personnel, then the accuracy of the results Is limited by the _ methodology and acuity of the sample collector. This report shall not be reproduced except In fun, without written approval of NVL Laboratories, Ina It shell not be used to doh product endorsement by NVIAP or any over agency of the Us Government — Page 2 of 4 NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Bulk Asbestos Fibers Analysis #102063 Client: PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 S 144th St Metallic paint Lab ID: 26040540 Client Sample #: 40407.007.22 Location: 4029 S 144th St Layer 1 of 1 Description: Tan fibrous material Non - Fibrous Materials: Fine particles, Glass beads Lab ID: 26040541 Client Sample #: 40407.007 - 23 Location: 4029 S 144th St Layer 1 of 1 By Polarized Light Microscopy Other Fibrous Materials:% Glass fibers 90% Description: Black asphaltic fibrous material Non - Fibrous Materials: Other Fibrous Materials:% Asphalt/binder Cellulose 70% Lab ID: 26040542 Client Sample #: 40407.007 - 24 Location: 4029 S 144th St Layer 1 of 1 Description: Black asphaltic fibrous material with granules Non - Fibrous Materials: Other Fibrous Materials:% Asphalt/binder, Granules, Mineral grains Cellulose 45% Lab ID: 26040543 Client Sample #: 40407.007 - 25 Location: 4029 S 144th St. Layer 1 of 1 Description: Black asphaltic fibrous material with granules Non - Fibrous Materials: Other Fibrous Materials:% Asphalt/binder, Granules, Mica Cellulose 35% Lab ID: 26040544 Client Sample #: 40407.007 - 26 Location: 4029 8144th St. Layer 1 of 1 Description: Black asphaltic fibrous material with granules Non- Fibrous Materials: Other Fibrous Materials:% Asphalt/binder, Granules, Mica Cellulose 35% Batch #: 2606591.00 Client Project #: 40407.007 Samples Received: 12 Samples Analyzed: 12 Method: EPA/600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: Ye None Detected ND Sampled by: Client A, Analyzed by: Nadia Prysyazhnyuk Data: 05/19/2006 Reviewed by: Nick Ly Date: 05/19/2006 Nic .5 °�[,a�1Q= miu =�•- J Note: tf samples are not homogeneous, then subsamples of the components were analyzed separately. An bulk samples are analyzed using EPA 600/R - 03/118 Method with the following measurement uncertainties for the reported % Asbestos (1% =0.3 %, 696=14%, 10%5.15%, 20% =1030 %. 50 %=40 40%). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is Ilmlted by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc It shall not be used to dalm product endorsement by NVLAP or any other agency of the US Government. Page 3 of 4 NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547,0100, Fax 208.634.1936 www.nvllabs.com Bulk Asbestos Fibers Analysis vl'o #102063 Client PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 S 144th St. Lab ID: 26040545 Client Sample #: 40407.007 - 27 Location: 4029 S 144th St. Layer 1 of 2 Description: Beige tile Non -Fibrous Materials: Vinyl/binder Layer 2 of 2 Description: Yellow brittle mastic Non - Fibrous Materials: Mastic/binder By Polarized Light Microscopy Other Fibrous Materials :% None Detected ND Other Fibrous Materials:% Cellulose 1% Batch #: 2606591.00 Client Project #: 40407.007 Samples Received: 12 Samples Analyzed: 12 Method: EPA/600R- 93/116 Asbestos Type: % Chrysotile 2% Asbestos Type: % None Detected ND Sampled by: Client Analyzed by: Nadia Prysyazhnyuk Reviewed by: Nick IN Date: 05/19/2006 Date: 05/19/2008 Nick Is, Note: N samples are not homogeneous, then subsemples of the components were analyzed separately. All bulk samples art analyzed using EPA 500/R 811110 Method with the following measurement uncertainties for the reported % Asbestos (1 %b3 %, 5%214%, 10%- 5-15 %. 20 % =10 -a0 %, 50%=40 40%). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except N full, without written approval of NVL Laboratories„ Inc It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government Pegs 4 of 4 Project: c0 ` -� . 144' ST Analysis requested: O , Date: 5 I t t ©60 Relinq'd by /Signature: mburv"�"��^� q � 7 -°' '" Date/Time: 5 )i &)° Ca c' 14 Received by /Signature .s / /�° Date/Time: 51) £106 OR 15 Fax results to: ❑ Brian Stanford ❑ Rudy Stoudt -McRae ,CL Harry Goren ❑ Ernest Edwards ❑ Michael Smith ❑ Tim Ogden ❑ Gregg Middaugh ❑ Janet Murphy ❑ Mike Smith ❑ Mark Hiley ❑ Willem Mager ❑ Other TURN AROUND TIME: ❑ I Hour ❑ 2 Hours ❑ 4 Hours S.Ndaaen` fficc Tech Ponca & TwirlateaUab Qain of- Qmtody.doc ❑ 24 Hours 48 Hours PBS Project #: 494-7 oo7 ❑ 3 -5 Days ❑ Other Lab Sample 8 A of -a —05 0¢ - o b -O8 ^/ - 12. —t3 Material Gw 3�7-+✓ zt.� rdrIE - eatc- %6,oti3 A v..aoti:v / (1'`'''cL) It u 1(• 4 .0- ) Gva iiksne- Aat L ) 9 -15 1 et..(4 1°i'-fsc at) Location L 2 PR. ie- OATH ccitcv3a4- [� N t32 * AFL- E 13R e 0g 5e 13 R. (1eA2 2e S 2 M sr y mil✓ SAT Lab \ PBS ENGINEERING AND ENVIRONMENTAL 130 NICKERSON ST. 1109. SEATTLE. WASHINGTON 91109. (206).233.9639. PAC: (206)-162.4310 Project: Relinq'd by /Signature. Received by /Signatur Fax results to: ❑ Brian Stanford ❑ Ernest Edwards ❑ Gregg Middaugh ❑ Mark Riley Z 5 , t4 vrt\ ` Analysis requested: (goo TURN AROUND TIME: ❑ 1 Hour ❑ 1 Hours ❑ 4 Hours SN'4anenVMafech Perms & Tenobtea\ ab O,aln-of-CLstedy.dee PBS ❑ Prudy Stoudt -McRae ❑ Michael Smith ❑ Janet Murphy ❑ Willem Mager 24 Hours 48 Hours Project #: 4°4 • 00 Date: 5111) oCo Date/Time: 'i) t S) 0G 0'2) 0 Date/Time: 5 J tglob oczI Is Harty Goren ❑ Tim Ogden Cl Mike Smith ❑ Other PBS ENGINEERING AND ENVIRONMENTAL, 130 NICKERSON ST. a109. SEATTLE. WASHINGTON 91109, (206 ) Fa: (106 »76] - 4710 ❑ 3 -5 Days ❑ Other Material is-rtit -- C.¢t ,�`oi - /AvIAA-tat;ni, titer V. K i' f Location 0 f FAP Ri-i 13,t 1t pvc. %3SMT ATT 0 -• (Z©oC- 8oDT L/s` 1a. - RF 1- 110 "- -r P act re-P•6 - 5140p Lab / , NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com All-IA -IN #101861 Analysis Report WA- DOE #C1765 AIHN ACCREDITED, LABORATORY Client: PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle, WA 98109 Attention: Mr. Harry Goren Project Location: 4029 S. 144th St. Lab ID 26040402 26040403 26040404 26040405 26040406 26040407 Client Sample # 40407.007 -LD -1 40407.007 -LD -2 40407.007 -LD -3 40407.007 -LD-4 40407.007 -LD -5 40407.007 -LD-6 mg/ Kg = Milligrams per kilogram Percent = Milligrams per kilogram / 10000 Bench Run No: 26- 0518 -4 Total Lead (Pb) Sample Weight 0.1960 0.2011 0.1976 0.1977 0.1999 RL In mg /Kg 51.0 50.0 51.0 51.0 50.0 Batch #: 2606575.00 Matrix: Paint Chips Method: EPA 7000B Client Project #: 40407.007 Samples Received: 6 Samples Analyzed: 6 Results in mg /Kg 2300.0 3500.0 530.0 60000.0 4700.0 Results in percent 0.2300 0.3500 0.0530 6.0000 0.4700 0.2004 50.0 5900.0 0.5900 Sampled by: Client Analyzed by: Ahmad lzzat Reviewed by: Nick Lv Date Analyzed: 05/19/2006 Date Issued: 05/1 Ifieolora RL = Reporting Limit = Below the reporting Limit Page 1 of 1 Project: A S VIA kit 5T Project #: 7i col Analysis requested: t;A Date: G / 1 L l d Relinq'd by /Signature: eg() Date/Time: I ) i 6 / 66- ° Si 0 Received by /Signature: Date/Time:l ` (fg/ 0 85 Fax results to: ❑ Brian Stanford ❑ Prudy Stoudt -McRae Harry Goren ❑ Ernest Edwards ❑ Michael Smith ❑ Tim Ogden ❑ Gregg Middaugh ❑ Janet Murphy ❑ Mike Smith ❑ Mark Hiley ❑ Willem Mager ❑ Other TURN AROUND TIME: ❑ I Hour ❑ 2 Hours ❑ 4 Hours S: Maztm ®ee1Ted. Farm & TetaplatesU,ab ClWa-of- Outodydoc ❑ 24 Hours 48 Hours PBS PBS ENGINEERING AND ENVIRONMENTAL, ISO NICKER$ON ST. 1107, SEATTLE. WASHINGTON 91109. (106).2.13.9639, Fix: (206}1624710 ❑ 3 -5 Days ❑ Other ACTIVITY NUMBER: D06 -280 DATE: 07 -21 -06 PROJECT NAME: CITY OF TUKWILA SITE ADDRESS: 4029 S 144 ST X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Issued DEPARTMENTS: /e t Building Div ion Public Works DETERMINATION OF COMPLETENESS: (rues., Thurs.) Complete Comments: APPROVALS OR CORRECTIONS: Approved ❑ Notation: REVIEWER'S INITIALS: Documenlshoming slip.doc 22802 PERMIT COORD COPY PLAN REVIEW /ROUTING SLIP Fire Prevention Structural ❑ Incomplete ❑ TUES/THURS ROU ING: Please Route Structural Review Required REVIEWER'S INITIALS: 1z PI nning Division No further Review Required DATE: DATE: Permit Coordinator DUE DATE: 07-25-06 Not Applicable ❑ Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: DUE DATE: 08-22 -06 Approved with Conditions Not Approved (attach comments) ❑ Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Business Owner Information Name Role Effective Date Expiration Date KEMP, PAUL W PRESIDENT 02/07/2001 Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2 % Washington State Department of Labor and Industries General/Specialty Contractor A business registered as a construction contractor with L&I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. License Information License Licensee Name Licensee Type UBI Ind. Ins. Account Id Business Type Address I Address 2 City County State Zip Phone Status Specialty I Specialty 2 Effective Date Expiration Date Suspend Date Separation Date Parent Company Previous License Next License Associated License RIVERES0000J RIVERS EDGE SERVICES INC CONSTRUCTION CONTRACTOR 601993602 CORPORATION PO BOX 39 KENT KING WA 980350039 2538728988 ACTIVE GENERAL UNUSED 3/7/2001 4/14/2007 RIVERES01101 RIVEREV981DE Bond Information Bond #2 Bond Company Name FIRST NATIONAL INS CO OF AM Bond Account Number 6097044 Effective Date 09/10/2001 Expiration Date Until Cancelled Cancel Date Impaired Date Bond Amount $12,000.00 Received Date 08/30/2001 https: // fortress .wa.gov /lni/bbip /printer.aspx ?License= RIVERES000OJ 08/08/2006