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HomeMy WebLinkAboutPermit MI2000-171 - ANDERSON RESIDENCE - DEMOLITIONANDERSON RESIDENCE City of Tukwila (206) 431-3670 Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188 MISCELLANEOUS PERMIT WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES, APPLICANT I'3 PROCEEDING AT THEIR OWN RISK. Parcel No: 004000 -0693 Address: 14630 46 AV Suite No: Location: Category: DEMO Type: MICPERM Zoning: LDR Permit No: Status: I_sued: Expires: M12000 -171 ISSUED 08/01/2000 01128/2001 Canst Type: Occupancy: DWELLING Gas /E1ee.: UBC: 1997 Units 001 Fire Protection: Setbacks: North: .0 South: .0 Eat: .0 West: .0 Water: 125 Sewer: VAL VUE Wetlands: Slopes: N Streams: Contractor License No: ASSISCC05166 OCCUPANT ANDERSON RESIDENCE Phone: 1466 46 AV S, TUJKWILA WA 98188 OWNER SEVERNS ROBERT WAYNE PO BOX 9206, SEATTLE WA 98109 CONTACT CASEY ANDERSON Phone: 206 - 243 -3264 4712 S 144 ST, TUKWILA WA 98168 CONTRACTOR ASSISTED CUSTOM CONSTRUCTIION 269113 204th AVE SE, KENT WA 98042 44,Ak* kkk' kkk********k AAk*k Ak# kkkk AkkkyYkk** kkkhkA* kktkkkkkkkkk4 *Ak #kk *AA4*kAkArkA *k AAA Permit Description: DEMOLISH EXISTING SO0 Sri FT SINGLE FAMILY RESIDENCE AND 400 SO FT GARAGE. *- kA•kk- kklkk *A *.h *:k* #'M *k• *Ak *k k• k•k*Akk,kkkk'k•khk kkk*k kkkk* kAkk *A4kkkktk *AkA4*kkk1k*kkk *A **AA Construction Valuation: t 4,200.00 PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: Curb Cut /Access /sidewalk /CSS: N Fire Loop Hydrant: N Nu: Sizetin): .00 Flood Control Zone: N Hauling: N Start Time: End Time: Lend Altering: N Cut: Fill: Landscape Irrigation: N Moving Oversized Loud: N Start Time: End Time: Sanitary Side Sewer: N No: Sower Main Extension: N Private: Public: Storm Drainage: N Street Use: N Water Main Extension: N Private: Public: *kkkAk * ** *AM'Akkkkkk kkk kk* kk* kAAk* k* Ak AAkkkkkkAkk# kAAAk1k* kkAkkkkkAAAAMAkAAAAAArA *1Ak4►+ TOTAL DEVELOPMENT PERMIT FEES: $ S1.50 M4vk*** k** k* k kM kkkk kkkAkAkkk*k *AkkAAkk AAA #kAA, AAA4j. AAkAArAAkkkAkk4Ak4.Akk4AAkkAAA + i Permit Center Authorized Signature:_ I hereby certify that I have read and examined this permit and know the same to be true and correct. Al 1 provisions of law and ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit dues not presume to ;dive authority to v1 o 1 t e or cancel the provision of any other state or local laws regulating construction or the performance of work. I yam authorized to sign for and obtain this ignature:_ development permit. .... C) ate : A 1 ? .t! Print Name:__ I 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, CITY Or TUKWILA ,ess: 14636 46 AV S Permit No MI2000-171 'S ti i L e reliant: Status ISSUED ,., type: mrscPERm i Applied: 07/19/2000 4 ParOell 1' 004000-0698 1 Issued: 08101/2000 . .• Permit Condi tions: • 1. • • • . • Tomporary• erosion ;.cOntrol...measures sbaii be implemented as '. •-..1 tile f I rst order of businOSSiitti pN•jimni.•:.•:.sadimentat i on off -. ', • A site or into ex i sting7sttim drainage facilft'les . • The site hvo con troT. Measures 1 ) place •• as Soon...ai'/Poss lb laaftar final grading has been • • : -,'tlOmp 1 e ted otiit>0410t, 40 the Final I nigect,1934,;,:- , • , 11.16 01 n g Oeryv5.9 ey$4,.Iiiil .14 require -• application n for a Hauling . .: -.'.10erMit pfi,:•0 ,t.45% pey :12ssoei td act i t■ fty'„ , '' '':',' ;..,-,.,, - •,, r: • _,,.;:,::, ANO*11"60,RX I C i;mRibiILTA Y%NSPEcfOR MR • GREG )11.A.ANUEVk.0.- , . .... ..... (2()600-41 79 OF .COMMENCOlt.NT AND POMPLETION dr, woRk.,,4i '‘:::,.,-, 'EA$[..., .4. MptiRs r 4 ,ADVANC.C. '',,, .' . . s. .,,... - •.-..,'! c61),:f. • crytitH(4..•lo,..Cation"=.:Of cap .for any existing storm •.-- -., . _ , . ,....„. '4 ' • • - ' ' f:- t " -f.d 0. - p 0, ww,connePts....,to the C114'. storm dram n ,sytteM. • -I.., ,,, • oc,P ''''' -'1, !;'4■.''''i ' • : . . V, .,..,1 . , leo' ,... ,44 '• ,,. ,_ ,•.''.. i :: -, ', f ; .,•,- . ..'. ' t..i.f• * \,, '.' ' '''''!' -' . i :- 1.. - -..: ., , : ‘'. ',. '.. ',.,' •• ' •••• ••••'• ?.10•4' -4 •:". . '.1 1, .. ' -,.; ' ' ' ,..'' . ,- • , . ' . . 1 - , ',...- . .... . ,. ' i• . • ,, .- •• • •z.J .; • , .• . • • • , . • • - - • : • CITY OF TL"'WILA Permit Center 6300 Southcenter Boulevard, Suite 100 Tukwila, WA 98188 (206) 431 -3670 FOP TAFF USE ONLY Project Number: 11 Permit Number: ,...W1t-CCO ` l Miscellaneous Permit Application Application and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mall or facsimile. Project Name/Tenant: L a 5 z-- 0, cde4 5c., .... ascription; 1 work to be don.: • Th 1tL ex ,%1-1- ( , J Value of Construction: 209 Site Address: 11.644* I i u �� �' City State /Zip: P)I Tax Parcel Number: oo cooC° . 9 Ppgperty Owner: L a5-- 1 d v' Phone: hone: ()OL) ?4,2.-3.2-6/1 Stre Address: P "d. „ I ii 5 t., I City State /Zip: u . tom , z (I) . c 916 Fax #: ) 01, ) 7'0-- — 7 7•11 ontact Perso P o treet A • dress: & -7-1Z 5, kty 51. •� City Stale/Zip: luru-(1 wP Cr(is Fax (Ot) >el) -/j 71 C • ntractor: B C- C. G u • „„ P one: 53 �3) -4004) re t : ddress: I8 2.oilth )4 ve 5 E City State/Zip: <v./0t w14 5'8 Fax #: OP 5)1.13�-1LlYcl' Architect: Phone: Street Address: City State/Zip: Fax #: Engineer: Phone: Street Address: City State /Zip: Fax #: M1sCEt: LANEOU9 ;pERMiT`AEVIEIN >'ANDAP.hAoVAL I►ikgUE$TEO: .4�BE;'FN:LED P L�iCAN , .... ascription; 1 work to be don.: • Th 1tL ex ,%1-1- ( , J Will there be storage of flammable /combustible hazardous material in the building? ❑ yes no - Attttacchh ilst of materials and storage location on separate 8 1/2 X 11 paper Indlcatln uantllles & Materlal e/et a Sheets =eve Ground Tanks ❑ Antennas /Satellite Dishes Bulkhead/Docks Commercial Remo, Demolition ❑ Fence ❑ Mechanical ❑ Manufactured Housing-Replacement only Parking Lots ❑ Retaining Walla ❑ Temporary Pedestrian Protection/Exit Systems ❑ Tem • ore Facilities ❑ Tree Cuttin APPLICANT;REQUEST,FOR MISCELUANEOUB PUBLIC WORKS PERMITt3'' .: ;a'." ` := :: ;` Channolizatlon/Striping ❑ Flood Control Zone ❑ Landscape Irrigation ❑ Storm Drainage ❑ Water Motor /Exempt # ❑ Water Motor /Permanent # ❑ Water Meter Temp # ❑ Miscellaneous Curb cut/Access /Sidewalk ■ Firo Loop /Hydrant (main to vault)N SIzo(s): ❑ Land Altering: 0 Cut cubic yards 0 Fllt_cublo yards 0 .eq. ft.grading/olearing ❑ Sanitary SIdo Sowor a ❑ Sowor Main Extension 0 Private 0 Public: ❑ Street Use ❑ Water Main Extension 0 Private 0 Public Sizo(o): 0 Deduct 0 Water Only Size(s): Sizo(s :. Est, quantity: DI Moving Oversized Load/Hauling gal Schedule: MONTHLY SERVICE BILLINGS TO; _" ; }' .1•111••••■••' >� � Name: Phone: Address: City /State /Zip: 0 Water 0 Sewer 0 Metro 0 Standby 'WATERMETER' DEPOSIT /REFUND BILLING: ':; r Name: Address: City /State /Zip: 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. The building official may extend the time for action by the applicant for a period not exceeding 180 days upon written request by the applicant as defined in Section 107,4 of the Uniform Building Code (current edition). No application shall be extended more than once, Date application accepted: MISCPMT.DOC 7111/96 Date application expires: Appl1 .,,fin taken by: (Initials) ALL IVIISCELLANEOU - RM!T APPLICATIONS MUST BE SI''' ITTED WITH THE FOLLOWING: ➢ ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN ➢ BUILDING SiTE PLANS AND UTILITY PLANS ARE TO BE COMBINED ➢ ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT ➢ STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED STRUCTURAL ENGINEER ➢ CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER (P.E.) © Copy of Washington State Department of Labor and Industries Valid Contractor's License. If not available at the time of application, a copy of this license will be required before the permit is Issued, unless the homeowner will bo the builder OR submit Form H -4, "Affidavit in Lleu of Contractor Registration ". ;Bti Id/ng►#AWher /Authorized Agana If the nppllcantle other than 1h@ owner, registered archltocyong lneor,,'or:conlraatorllaerised,. by/ 1R'Sttrto,o(Washington,`. a notarized+lottor.from•tha propoityownerauthorizing tho_agent to submlt•ihls perrnhlappllaatlon a` !obf. lln:fhu permit will bo regtlir dfas �arf ?af thIs aubmitlal.• I HEREBY CERTIFY THAT ! HAVE READ AND EXAMINel11"HIS 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" • WNERsORAUTHORIZED AGENT:. •Signature: Mffifiliir -- .,,,,......__w_ Date: 1 <t SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR PERMIT REVIEW ri .Above°Ground:Tanks/Water Tanks • Supported ;directly upoh •grade . exceeding 5 ;000 •gallons-and'a ratio of height to diameter or width :.which,exceeds:,2 :1. . .Submit checklist ; CITY OF TU 'WI LA Permit Center 6300 Southcenter Boulevard, Suite 100 Tukwila, WA 98188 (206) 431 -3670 KI M -3 Submittal Checklist Miscellaneous Permits DEMOLITION ✓ Site Plan Requirements between structures and property lines ✓ Working Drawings InDistance Abandonment of Se •tic Tank for residential re • ulres the followin s conditions be met: Ell 74 Existing landscaping Dismantle /destroy cap , Letter or recei • t to veri above conditions have been met b • um •ins service Building location and total square footage Haulin s re • uirements must be met if over 50 cubic ards of material is to be taken to or from site Fire Protection S stem Demo issued throw s h Fire De • artment High water mark of river if within 200 feet of shoreline Identify water meter size MI Foot print and location of structures to be removed Temporary/permanent erosion control plan MI IMII V Two (2) foot contours on site Points of access for demolition activities Limits of area to be disturbed by demolition activities IMLocate INIONIIIIIIMIMINft existing sanitary side sewers and points to be • Iu • • ed/ca • ed at • ro • e line Locate existing water meters, identify existing meters to be removed by City Public Works staff, Identify existing water services to be ca• •ed b demolition contractor. Identify existing Bide drain: modify and /or capped pi of slopes 20°x6 or greater, wetlands, watercourses and their buffers Additional Requirements Asbestos Abatement: Obtain approval from Puget Sound Air Pollution Control Agency prior to proceeding with demolition If structure to be demolished is over 4000221.1 SEPA checklist Is required? Construction debris to be taken to debris facillt Kin, Count Informational handout available at Permit Center Foundation must be completely removed Abandonment of Se •tic Tank for residential re • ulres the followin s conditions be met: Pump tank empty Fill with Sand Dismantle /destroy cap , Letter or recei • t to veri above conditions have been met b • um •ins service Identify current sewer /water billin s account number Haulin s re • uirements must be met if over 50 cubic ards of material is to be taken to or from site Fire Protection S stem Demo issued throw s h Fire De • artment An Inspection prior to demolition will be made and again at mid-demolition and after work Is completed, BOND - A bond must be made In amount equal to the cost plus 1O% and must be posted prior to issuance of permit. (Bond may be made in the form of surety or secured by a deposit in cash in the amount specified with a banking or escrow agent acceptable to the City, and conditioned as in the case of a surety. A surety shall be in form joint and several, shall name the City as obligee. This bond is required to be done in order to comply with all the conditions of demolition permit,) Title 16 City of Tukwila Ordinance 1393, 1986 7/96 00 Nw 0w wa w .g O §s2 u. Czvx r 4 9.0.4 Puget Luund ,6Ency 110 Union Street, Suite 500 • Seattle•WA•98101 -2038 (206) 343 -8800 Guidelines for Application to Perform a Demolition Who must file for a demolition permit? . Any property owner who is going to burn or demolish am structure, including, but not limited to, commercial buildings, or abandoned structures on private property. The purpose of the permit is to certify that the building is asbestos -free prior to demolition. Why must 1 file for a demolition permit with PSAPCA? 1 already filed one with the building department. Building departments do not regulate asbestos. Federal law requires the filing of a demolition permit with the Puget Sound Aix Pollution Control Agency, and removal of all asbestos. What should I do first? You must hire an Environmental Protection Agency (EPA) accredited inspector to survey. your structure for asbestos. A copy of this survey must be available for inspection during demolition You cannot demolish a building with any asbestos still present. Look for qualified inspectors in the yellow pages under Asbestos Removal, Laboratories Analytical, Building Inspection, Asbestos or Environmental Consulting and Testing. What if the inspector finds asbestos in the building? If there is asbestos in the building, it must be removed prior to demolition. You must hire a 'certified asbestos abatement contractor for removal. What do 1 need as far as paperwork is concerned? A completed Application to Perform a Demolition (2) $25 check payable to PSAPCA. ® Copy of survey stating the structure has been inspected and no asbestos was found, or an Application to Perform an Asbestos Project filed by an asbestos contractor to remove any asbestos in the building. • Please include all of the required paperwork with your application or a permit cannot be issued. How long will ittake? You may begin demolition on the 11th - working day after you have provided us with the required information. Your approved Demolition Permit will be mailed to you within 10- working days after receipt by the Agency. FSAPC.A Form No. 66- 181(5/'94) jrs oil I y st k* ilt**4*** 4 ;11Y/.elr***4** * *hl * *4 *trl4!t•k ''•4h *A *A$444* 144 ** *wk4:tAhA44 4 Y.ar :lUkWzi. 101 _ 411rA ** 11** 4* 44. ** *4A** *A�►bA:4It4**A4 #a *^t{�r ;744 t� at Ak*AAkA*4.4f * / *** fPPINONI1 l umbtr s P9000*15 AmooNt : 51.1.4 0E001/00 0909 l'aym0i1t tlothidx 1.`141.1 It i4ut't ions CASEY r1a11>E1 OnN in,ts NUR M wr r •W MC M Mi Na •d •µ p •• t , 14 M as • 1 'N •• a w : r • ' • N. ■• ••• .♦. • e • ♦ • ., • N ••♦. ••• •. I!.•a r•••N ♦• •••:t N... ri•.•. 1►or4wit leas MI2000,0t i Typo: 14114CPERM i4XJC1i1.1•ll601113 i':It;ttT P ,lct l Fla z OO4Otfnr 0 9+ 3 f to.,,t3ddrarsuz. 14636 Icy Ay 9 yment 4494 Ot*A*04,4 t Geouilk Cudft. 000 /322.100 dti '.00o/ a4. ±04 Ys. p w Tate, 114out 1. 0 tot H 1 ALL Hots* 3 Oalancol A*4 *4hk4 4AA *A4kmhk** *A *E111r** bv(J1` i pt 1(Hi UUfl,,)7H( - HC1!'1kE:ti • 9TflT1; IUT1•iDXNG 9URt.I41411o1z • •. •: M • • • - • + IV. y •• • •• • • •• •. H v. ••• •• I M M ,o • P f! • a • f N 31.30 %.50 .QU 4bhh4Lhfr I�IAQl111 t 47.00 4.30 644? O8 /Oi. ?717 TOTAL ' 51.50 --, INSPECTION RECORD Retain a copy with permit INSWE ION NO CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 (206)431 -3670 Project: Type of Inspection: Ad re b 40, � Date called: 9 Special instructions: Date Requester: Phone: Epproved per applicable codes. ED Corrections required prior to approval. COMMENTS: ,,•� -'' ED $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid _ at 6300 Southcenter 9lvd. Suite 100. Call to schedule reins'ection. Receipt No: I . ' M INSPECTION RECOR Retain a copy with permit dNSPECIION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 1,1 PtRMIT NO. (206)431-3670 Project: - a biL -)1( la Type of Inspection: Pr — 1)treNC) Address: or) Litt Ail gate called: Special Instructions: Ple65e ee/ 1 froaiiii hal r b' tor e 4 r r 1 vilie Dte a wanted: - —, - a,rti, Requester: Phone: _9b C i Approved per applicable codes. 1:3 Corrections required prior to approval. COMMENTS: $47,00 REINSPECTION FEE REQUIRED, Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reins ection. 4d, •‘• ,• • •„ . • „••,„,•, H20mo o soMeo Cau.,v Anderson (206) 243 -3264 Plot Address: 14636 46th Ave S. House: 500 sq. Ft, Garage: 400 sq, Ft, (Dirt floor) rb' INdrani standwrd to eC b *io dssigrE draavtr:: tor Imri1 Miss t+ i veel by the iTl81M for (sine- N ,...,..., . . crs .'1s IRnal OS r"WINii it it b"NJ MN " / ►1 + "; 4. esavgamairstrias affiS l s` ^- ''pan «" b, Iy . ' o c� n ce fs 8p, t • y . thortre to , I:41. 'mil! �� � � the �� %,. is , h_ 1 44 's Ivi,'; .i44"iii. 444 Ai_ �n yes KWILA III 9 2000 / PERMIT CENTER tlr2000-rlI Agency Case No. 200001054" . PUET SOUND CLEAN AIR AGENCY 110 Won Street, Suite S00, Seattle, WA 98101 -2038 NOTICE OF INTENT TO PERFORM: A. Pro.kat Type: I 1.0 Asbestos Removal B. Property Owner: l._ �� e. �/ /`t YI tJl'+tr'.Y' S � Phone: (7 ) 2 `" 3) 6' 9 Property'Owner's />� G Mailing Address: li • ,off- / % II ' 'id.. City: I IJ A w /1 a. State: %t/r� P", Data R Sewed' • JULO 6:2000 • sr, .LAB+figY..tin Onlr.rt+ [ 2. D Asbestos Removal & Demolitlan 13. Deo:elided, No Asbestos fiemoval C. Asbestos rrIAsr maw TIM M, . al TOUR WWI wutava XL Contractors ■ Contractor Owner/CEO: Manias Address; PIIIIIIIIIIIIIIP•PMP-tgrllMMMIIIIIIIIII ■ Tr to ' gist Fire Dept. as demo on contractor beldw) D Ordered Demolition attach co of Order ' • Phone' • Contractor Job No:: Fax: R. rebeetos Survey or No. of Man Presumed: Structures: AHBRA Bulldin j M AIM SURVEY UMW) MINI AIL OSNOLMON PROJECT Data Survey was Conducted: Inspector Name: Asbestos Found? - ■ Yes 21W tf No Attach Survey Bstp n Certiticadon No.: 0. 3o P. Demolition Isefinsuideat No. of 3 Stnsoturee: Dater ,0 I ■ Tr to ' gist Fire Dept. as demo on contractor beldw) D Ordered Demolition attach co of Order ' • Contractors Amman Nita NNW AOOAUrw C. G • C. ti o t c ,p1 /ONDAM IPTPJNPN°nemOTZat+l1taiR:NW g _ Phone:(;) (7 i j —006 fl. t T7 ea PreOset Catssoriess . • i • • . 1 :.... 1. 6 Ownsr•Ocoupied. SinS1e -Fan sly Residence Aabeitos Removal Project • Prior Notice : • 1 J i 1 ._.1:..1 • . _ ,: • lido • Pro ect it No. a Structures: , /7 sea bac _ * 1 ' . 7 Start ' , Completion • • D _ • . $23.• . • ,w 411,1, '114 • . Wk. Days M T W i . • s: � '• l r 11 • t., :., "c' 11" , • 3 D s' • Totitt . .. be ' @moved: Dare Ft.' " 1 -1 • ' ,, , a. 7'7'7 .. [anal be . .. ,,.. . , • ' Yes ■ ,, . Thermal S stem, Onion; ■ r'" . • ace Ins. • Duct its. ■ P1 ias. •, • 7. ■ 1 i l l . 99 999 linear feet or 100 000 . 149 • 9 • tare i x�N Cie'",.... ►V , • S. ■ 100 000+•1 • . •tor 130 000+ uare - 1 . ' • 10 Da s ■ ` , , • ‘ o ■ • l 71T =• ri M'tPT17,11"r""-' Other: ' ; T • • ' t Fee 10. ■ Alts eats of Co ' . . e for friable materials ' ' • 0 - « , do . 0-Da Revie ' 'clod • . - i Milo. Mat'l: ■ M►' at Ad. ° Cement Pips " Marisa iNst'1 is Mm''.'", met Otttae: Twice Pro ect Fee . fl. t T7 ea PreOset Catssoriess . • i • • . 1 :.... 1. 6 Ownsr•Ocoupied. SinS1e -Fan sly Residence Aabeitos Removal Project • Prior Notice : • 1 J i 1 ._.1:..1 • . _ ,: • lido • Pro ect it jd0N. DARL . $23.• . • ,w 411,1, '114 • . IlilleilEvi rte„ . =. Ii71 ' ._ .,_..� :.� M. ' , _•� T,. . J i vi � '• l r 11 • t., :., "c' 11" , • 3 D s' • 0 MM. 00 • SO . . ! . , , _ 0 Da . ■ 1 000 - 9 : • ._ fest or 3 000 — 49 999 • um* lest 1tLtarr'►`i.`7 C a 10 Da s ' d. ■ 10 t s t • 49 999 _,_ feet or SO 000 - • . 999 . taro es Kalb ..11. r".+eG 10 Da • $2 000 7. ■ 1 i l l . 99 999 linear feet or 100 000 . 149 • 9 • tare i x�N Cie'",.... ►V . 3 000 S. ■ 100 000+•1 • . •tor 130 000+ uare - 1 . ' • 10 Da s . $ 0 000 9. ■ • ,. Asbestos Pro'ect or Ewan • an • Deu oliti . Pro ect • • or Notice • ' ; T • • ' t Fee 10. ■ Alts eats of Co ' . . e for friable materials ' ' • 0 - « , do . 0-Da Revie ' 'clod • . - i 11. • Alternate Mesas of Co .. • Hance for nontriable asbestos. materials Concurrent with Pro ect . Twice Pro ect Fee I. I do booby artily that the iatoomadoa conaslasd to this nodfcadoa, and supplemental data dcacdbcd hada: is to Ott best of my bwwi4dge accurate sod compkta, J shall Dot cause or allow say asbestos pro)at or damoUdon activities to basin vaal the sppruj*ta s waiting period has sloped. OR The Puget Sound Air Pollution Control Agency (PSAPCA) is the local air pollution authority for Snohomish, King, Pierce and Kitsap Counties. PSAPCA's Regulation 113;Article 4,•requires advance notification be submitted to PSAPCA,•on Agency. approved form no. 66 -160 ((revised 10/96), for any asbestos project involving materials equal to or•greater in size than 10 linear feet or 48 square feet and for any demolition project, regardless of asbestos content, involving structures with a projected roof area greater than 120 square feet. Notices of Intent should be mailed or hand delivered to PSAPCA, (address on reverse side) with the appropriate project.fee, A PSAPCA representative will review the notification, and if it is completed correctly a'copy will be returned by mail within 3 to 5 days to the mailing address entered in box C and box J/ The rieturned•copy,wili be your valid notification. Asbestos and demolition nroiects involving materials and structures below the notifi5ation thresholds listed Above ire still subject to'ill other reajdrements of PSAPCA Regulation 111 Article 4. I/1, I• III 14. 1 I •, 1 1 1 •81II.• ,III Mauling Address: 2. CitY: ,. -v 1 t Phone: 05 3) b'31-6ew& Contractor's: Job #t: Stars: _zip,: 9'00 //?. Fu: (15) L I - I I-I 81 GUIDELINES FOR SUBMITTING A NOTICE OF INTENT Enter all applicable in formation accurately and completely. Incomplete Notices of intent will be returned. Box A. Check the approprtiate project type. Box B. Enter the legal property owner information , Box C. Enter the ubestos contractor information, or "not applicable" (N /A) for demolition projects when no asbestos- containing materials are present. For an Owner Occupied, Singte•Famlly Residence asbestos removal' project (project category 1111), .bast the asbestos removal contractor or property owner doing the aabs/Stos removal (include property. 'owner's mailing address). Box D. `Enter.the asbestos removal or demolition site address. For an Owner•Occupied, Single•FemIly Resldeneie asbestos removal project (project category Ht) where the property owner's mailing address Men from. the site address listed in Box D, a letter must accompany the Notice of Intent verifying That the structure located at the site address currently being used as the property owner's domidk. Multiple asbestos/demolition . projects involving: more than one siructure (project category H2 through 118) must ba submitted in accordance with PSAPCA Regulation I, Section 4.03(a)(7). Box E. Enter the ubestos survey information or check material presumed (for asbestos projects only), An AHER1 building inspector must conduct an asbestos survey prior to any, demolition project (1.e., the wrecking, razing, leveling, 'dismantling or burning of a structure, making the structure permanently uninhabitable or unusable), , Box F. Enter die demolition project information. If the structure is to be used in a training fire, list the lire department , responsible for conducting the bum as the demolition contractor In Box 1. If the property owner has been ordered to perform a • , demolition by a government official, submit"' copy of the order from the appropriate official. Box G. Enter all asbestos project information or enter "N /A" for demolition. projects with no asbestos removal.requlred. All multiple structure asbestos projects (project category 1110 and, HI 1) must be submitted with a wo_, rk plan. moo of the snructu_; • II ' • • 1 - % 0. I • II 04 1 • 1 11. • 1 .• • - 1- 11 • v 11 11 • . 1 • Bona. Check one project category ry In boxes 1 through 8. The j eCt fee includes the demolition foe. Asbestos removal" projects and demolitions with an asbestos removal Involving less than 10 linear feet or 48 square feet may be filed as project category 3. An emergency asbestos project or demolition may be requested by checking the appropriate job size category in boxes 2 through 9 and then cheektng the applicable emergency bpx in category 9. Emergency asbestos. project notifications must be submitted with a letter from the property owner explaining the necessity for the emergency. Emergency 'demolition notifications must be submitted with a letter from an authorized government official or a licensed suuctursl. engineer documenting that the structure is In Imminent danger of collapse. To request an alternative moans of compliance for,friable or nonfriable materiels, check the appropriate job size category in addition to the applicable box in categories 10 and 11. A work plan must bc.submitted by an appropriately trained individual along with the notification. Box I. Sign the notification eertifyipg the accuracy and completeness of the information provided on the form. , Box J. Enter demolition contractor mailing information (on back). fiendetory amendment,I are required for changes that increase the project type, job size category,. the .types of asbestos materials to be removed and work schedule changes. No fee is required for work schedule changes if the contractor is. participating in the Agency work schedule fax program. A $50.04 processing fee is required for all other amendments. For technical assistance, contact Tom Hudson at (206) 689 -4058, Larry Vaughn (206) 689.4035 or Kwame Agyel (206) 689 - 4054. For inquiries cancqujoit gotificatiot and r rendiont s ,is contao, a Morgan at (206) 689.4090. . PSAPCA Forte No 66.160 (Rovisod•498) AClM1'e! !' P /P'd i. AD1•1363- 1IU RITID Q f10S 13Sild 1.1dSt7 : t0 00. 170 AUW ant PERMIT COORD COPY PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: MI2000 -171 DATE: 7_ _19N2000___ PROJECT NAME: CASEY ANDERSON DEMOLITION SITE ADDRESS: 14636 461" AVE S Original Plan Submittal _Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Is Issued DEPA,NTMENTS: Bp_ aiding Division II Fire 01.tion Mision Plann II 1_t _ou fit. 1-2)'0) K!„ 1 -M') ubIlc Wor e .1- Structural ❑ Permit Coordinator • JM DETERMINATI OMPLETEN(: (Tues., Thurs.) DUE DATE :, 7 -20 -2000 Complete Incomplete ❑ Not Applicable El Comments: TUES /THURS ROU NG: Please Route Structural Review Required REVIEWER'S INITIALS: No further Review Required DATE: APPROVALS OR CORRECTIONS: (ten days) Approved El Approved with Conditions REVIEWER'S INITIALS: DUE DATE: - -QQ, Not Approved (attach comments) ❑ DATE: caRRNIIQMMIE A IO : DUE DATE Approved E Approved with Conditions I Not Approved (attach comments) E REVIEWER'S INITIALS: DATE: 1PRROUTE.000 5/99 07/91/2000 09:53 4254321489 ►All,n.il,o 11' H ACC INC DEPARTMENT OP LABOR, AN 3 INDUSTRIES REGISTERED AS hROVID b AY LAW AS CONS'I Corry GENERAL REQIST.' ft Can. ASSISCC051116 BFFEC'VXVE ,DATE ASSISTED CUSTOM CONS 26918 204TH AVM SE K 1?T WA 98042 XP. DM'a 1/26/1995 INO PAGE' Anti bh1IIu) C'rnhk; W -- -M-- -+ CONTINUATION CERTI (Fur LNG On Surety on STATE PAI4M PIRU AND CASIJ 8LOQMINGTON, ILL,IN ICATE of LTY COMPANY I5 Yi►e STATE FARM FIRE AND CASUALTY COMPANY lbw sinew celled the Company) hereby