HomeMy WebLinkAboutPermit MI97-0143 - ANDERSON RESIDENCE - DEMOLITIONThis record contains information which is exempt from public disclosure
pursuant to the Washington State Public Records Act, Chapter 42.56 RCW
as identified on the Digital Records Exemption Log shown below.
M197-0143
Anderson Residence
4304 South 124th Street
RECORDS DIGITAL D- ) EXEMPTIO
THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION
Page # tode Exemption = 8rlef Explanatory DeSclriptiop �t�tutel ule
The Privacy Act of 1974 evinces Congress'
intent that social security numbers are a private
concern. As such, individuals' social security
Personal Information —
numbers are redacted to protect those
Social Security Numbers
individuals' privacy pursuant to 5 U.S.C. sec.
5 U.S.C. sec.
DR1
Generally — 5 U.S.C. sec.
552(a), and are also exempt from disclosure
552(a); RCW
552(a); RCW
under section 42.56.070(1) of the Washington
42.56.070(1)
42.56.070(1)
State Public Records Act, which exempts under
the PRA records or information exempt or
prohibited from disclosure under any other
statute.
Redactions contain Credit card numbers, debit
card numbers, electronic check numbers, credit
Personal Information —
expiration dates, or bank or other financial
RCW
25
DR2
Financial Information —
account numbers, which are exempt from
42.56.230(5)
RCW 42.56.230(4 5)
disclosure pursuant to RCW 42.56.230(5),
except when disclosure is expressly required by
or governed by other law.
City of Tukwila s
(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 IS PROCEEDING AT THEIR OWN RISK.
Parcel No:
Address:
Suite No:
Location:
Category:
Type:
Zoning:
Const Type:
Gas /Elec.:
Units:
Setbacks:
Water:
Wetlands:
017900 -0320
4304 S 124 ST
DEMO
MISCPERM
LDR
DEMO
001
North:
TUKWILA
Contractor License No:
Permit No:
Status:
Issued:
Expires:
MI97 -0143
ISSUED
11/06/1997
05/05/1998
Occupancy: DWELLING
UBC: 1994
Fire Protection:
.0 South: .0 East: .0 West: .0
Sewer: SEPTIC
Slopes: N Streams:
OCCUPANT ANDERSON KIM
4304 S 124 ST, TUKWILA, WA 98168
OWNER ANDERSON KIM M Phone: 206 763 -7349
4304 S 124 ST, SEATTLE WA 98178 .
CONTACT JOEL ANDERSON Phone: 206 763 -7349
4304 S 124 ST, TUKWILA, WA 98168
r * * * * * * **** * * ** tilt* * * * ** * ** tit * * * ** ** * * * * * * *** ** * ** k**** * **** ** * *** * ** * * *** * * * * * * * * * * ** A
Permit Description:
DEMO AND DISPOSE EXISTING SINGLE FAMILY RESIDENCE.
SEPTIC TANK ABANDONMENT AND WATER SERVICE
CAPPING.
r**************************************************** * * * * * * * * ** * * * * * * * * ** * * * * * * * * * *4
Construction Valuation: $ 2,500.00
PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: SAL
Curb Cut /Access /Sidewalk /CSS: N
Fire Loop Hydrant: N No: Size(in): .00
Flood Control Zone: N
Hauling: N Start Time: End Time:
Land Altering: N Cut: Fill:
Landscape Irrigation: N
Moving Oversized Load: N Start Time: End Time:
Sanitary Side Sewer: Y No: 1
Sewer Main Extension: N Private: Public:
Storm Drainage: N
Street Use: N
Water Main Extension: N Private: Public:
.**************************************************** * * * * * * * * * * * * * * * ** * * * * * * * * * * * **.
TOTAL DEVELOPMENT PERMIT FEES: $ 2,816.50
*********************************************** C***** * * * * * * * * * * * * * * * * * * * * * ** * * * * * * *�
Permit Center Authorized Signature:_
__ Date: ti —&
I hereby certify that I have read and examined this permit and know the same
to be true and correct. 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 state or local laws regulating construction
or the performance of work. I am authorized to sign for and obtain this
development permit. hel2 ,7
Signature
Print Name:_
Date L.57
7
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.
■
Address 4304 .
Su'i te':
Tenant:
Type: MISCPERM
Parcel ` #: '017900-032'0
*•1444 k** * **•k•k•k•k-k•kk ** * **•k *•k'k•kYc** * * * *'k ** * * *'k*
ermit No: :M197=-0143
Status ISSUED,
.Applied 08/2.211997:;
Issued:.,. 11/06/1997'
•kk * **;kkk•k•14` *lik** * ***It'k•kk ,k k* ; ;k,k.k
PerrMit• Condit ions:.
charges wi 11, b`e, made, to the plans • un l ess approved. : by .the;. ,.
{Architect or Engineer and Division
• 2. All permits. • i nspe.co on s:r^eca "rds, � :'and, - appr,ove�i plan', ha 11 'be
:avai lable :at • the j,ob; s.j'..te "prior to the star t..of any;con
s►tr�uct i on : The;se tfocumen;ts! are to be ma i nta fined ; hnd ava1,1—
able until final inspection. approval, i,s grunted
All construciiirin to be dine i i confo`rrnancrye with ap'pr� v,ed
plans • and ,,,regi i rererits 3•of the .Un.i:form
Edition);as:=`'aner,ded,
'Vail dity, 0t Permft•:` .The issuanve of a per init or approval ''o
plans, sp'ec i f i cations, and computat:i ons sha 1`1' not,,,be,.•:con -•
trued ;to be a permit for ,!‘„'Or an approval of , any v16{lat1 '
of .arjr,,':of the provisions.' of the bui iding code or ',of .any;,,,
;oche ,,,Qrdirtan.ce•;of the,':•;jurisdi;ct.ion. No permit pr +esuming t
giver,aithortty to violate or cancel- ',•the provisions' af ° °tf %is
codes sha l'o1.,b`e ua 1 i d ,., . '': ' •,,..
Temp,Qrary+ erosion control ,,meas`ures :shall 'be• i mp`1 errien ted tas
theJf first oar` der .of bus ines$; to ; °p, }re'verit•'sedimentation'' off =;.
ibex' :or - in,.to ex'is'ting s,torgi',;,drainage rt cl 1 .1es } ;�r
8 : . Anyi ` #rept tc,,s•tank i,n' the ° ar`�'ea'.'`sha l 1,.t be purnpe:d empty aril ,,,;:,,,,,..
reni9'ved{.',� YA copy n.f- ,docy mein t:at'ianl truni the, 'busimess '
tha't•,�',� erforme�, the,:•Rump/1n ,g,,, sha11., be,` •pr ov i ied •
to the City ptKi 1 i t i es ,.Inspector "..'� !r ' ',e , ,h
ALL C N:� ;•R`UCTI0N ACTIVITY. ASSOCIATE :,W.I TH THIS, DEMOL ITION
SHAL �l}BE La /al-ED TO WITHIN 10' OFA,sTHE :' \B .J.:DINGLEXT.E'RIQ t�-
8: :Water scp er 11t,rre sha.l l be capped atilthe watee;,,,mater.; '
• t 1 i. 1 ` i
1.1'•14 a E `
CITY OF TUKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
OR STAFF USE ONLY
Project Number:
.Permlmumber, "lT7 Q Lt 5
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:
Pe WLrTo�! or-PE
At- feriz
et, �E
V ue of Constructlo
t;�v+� SOCK,v0
Site Address:
4 o�i- �. 171{ -�ri
j 1f4 ft-,r
City State /Zip:
RSIGS
Tax Parcel Number:
tot7laa -o3io
Property Owner:
Joy 4 KIK ikt4VM2-1-1
Address:
Phone:
7e3-73.4-1
Streit Address:
1469 • L4-t4 j -SIC t<1 I(
City State /Zip:
q8 6s3
Fax #:
Coact Person:
ort, A+
�
r�iW�l
0 Metro
0 Standby
Phone: 7� 7 .4R
3-. 3
Street Address:
/AML
City State /Zip:
Fax #:
Contractor:
Phone:
Street Address:
City State /Zip:
Fax #:
Architect:
Phone:
Street Address:
City State /Zip:
Fax #:
Engineer:
Phone:
Street Address:
City State /Zip:
Fax #:
MISCELLANEOUS PERMIT REVIEW AND APPROVAL REQUESTED: (TO BE FILLED OUT BY APPLICANT)
Description of w
0
rk to be done:
dFF t 62-8
er,
Will there be storage of flammable /combustible hazardous material In the building? ❑ yes no
Attach list of materials and stora a location on separate 8 1/2 X 11 paper indicatin uantities & Material Safet Data Sheets
Antennas /Satellite Dishes ❑ Bulkhead /Docks Commercial Reroof
❑ Fence ❑ Mechanical ❑ Manufactured Housing- Replacement only
❑ Retaining Walls in Temporary Pedestrian Protection/Exit Systems
❑ Tree Cutting
LJ j�bove Ground Tanks
Demolition
❑ Parking Lots
❑ Temporary Facilities
APP. LICANT -REQUEST.FOR:MISCELLANEOUS PUBLIC WORKS PERMITS
IJ Channelization /Strlping
❑ Flood Control Zone
❑ Landscape Irrigation
❑ Storm Drainage
❑ Water Meter /Exempt #
❑ Curb cut/Access /Sidewalk ❑ Fire Loop /Hydrant (main to vault) #:
J.erf"id Altering: 0 Cut cubic yards 0 Fill cubic yards 0
❑ Sanitary Side Sewer #CMG M1O❑ Sewer Main Extension
❑ Street Use ❑ Water Main Extension 0 Private
0 Deduct
Size(s):
❑ Water Meter /Permanent # Size(s):
❑ Water Meter Temp # Size(s). : Est. quantity: gal Schedule:
❑ Miscellaneous Moving Oversized Load/Hauling
Size(s):
_sq ft grading/clearing
0 Private 0 Public
O Public
O Water Only
MONTHLY SERVICE BILLINGS TO:.
Name:
Phone:
Address:
City /State /Zip:
0 Water
0 Sewer
0 Metro
0 Standby
WATER METER DEPOSIT /REFUND BILLING:
Name:
Phone:
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:
Date application expires:
I
Application t y: (initials)
ALL MISCELLANEOUS PER APPLICATIONS MUST BE SUBMI
ti
• 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.)
D WITH THE FOLLOWING:
❑
SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR PERMIT REVIEW
Above Ground Tanks/Water:Tanks - Supported:directly�upon grade
exceeding 5,000 gallons and a ratio of height to diameter or width,:
which exceeds 2:1.
: Submit checklist ,No:' . M -9
❑
Antennas /Satellite Dishes
Submit checklist ' No: M -1.
❑
Awnings /Canopies - No. signage
Commercial Tenant Improvement
Permit
❑
Bulkhead/Dock
Submit checklist • No M -10 •,
❑
Commercial Reroof
Submit checklist, No M -6
❑
Demolition
Submit checklist , No :M-3;, M -3a .
❑
Fences - Over 6 feet in Height
Subrnit checklist ' No: M -9
❑
Land Altering/Grading/Preloads
Submit checklist' No: M-2
❑
Loading Docks
Commercial Tenant Improvement
Permit. Submit checklist No: H -17
❑
Mechanical (Residential & Commercial)
` Submit checklist: 's. No M -8,
Residential, only = H -6,' H -16 :..:
Submit checklist No H -9
❑
Miscellaneous Public.Works Permits -
❑
Manufactured Housing (RED INSIGNIA ONLY) :
Submit checklist ` No M -5`
❑
Moving Oversized Load/Hauling
Submit checklist': No :: M =5''
❑
Parking Lots
Submit checklist No: M -4
Residential Reroof - Exempt with following exception: If roof structure
to be repaired or replaced
Residential Building Permit
Submit checklist No: M -6,,
❑
Retaining Walls - Over 4 feet in height .
Submit checklist No M -1
in
Temporary Facilities
Submit checklist : No: M -7
❑
TemporaryPedestrian Protection/ExIt'Systems : ::
Submit checklist: No:. M -4
❑
Tree Cutting
Submit checklist.. No: M -2
❑ 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 be the builder OR submit Form H -4, "Affidavit
in Lieu of Contractor Registration ".
Building Owner /Authorized Agent If the applicant is other than the owner, registered architect/engineer, or contractor licensed
by the State of Washington, a notarized letter from the property owner, authorizing the agent to submit this permit application and
obtain the permit will be required as part of this submittal.
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 OR AUTHORIZED' AGENT:
Signature: - % y
I
.,
/, „
Date: . -. , N / t
Print name: 4/.//'
S
-
- ' _
Phone :. R ,-/-:, G
Fax #:
Address:// ,-
,.-
,.. 1,1 i
City /State /Zip: f s
c.c41
:
MiSCPMT.nnC 7/11/96
k4 *A* kA 4A44, * ** *k *i,**AA•A•**A * *4 **•A4 *10A4k #K * * .AkVAA*
:ITV OF TUKWILA, iWA TRANOMIT .
A 'dW*•khA * *.***A* :R *Ak ** *'h **A f)') ** * #c 0* • *k *% t1k * * *A s4 tt *k **kdfi*
''rKANSMx r�' :Number: (1370067b :•Amount: 2,7:10.00 11/06/97,11:15
raymerit< Method: CHECK Notation: KI:M. (.NC)EP$ON 'Ka')
Permit. Mot •,M197-'0143 •Type: MI1C,PERM MI k :LL.ANECIUF; ,PERMIT‘
Parcel No • 017900 -32(? •
i'te Addr'e5at .4 )04. x'124 81•:
-This P,.<)iment
* * *d * *A.* *1:4 *ro4 * * *. * * *.h
Account.. :Code
00Q/386.908
fatal Fe: 2,f31G'.50'
2,,.51) 09. Total .ALL Pmts. 2,13iC,50
:Balance .00
* *74. “.i0****iA *A*i *'A *+•A• *,< *•A *�k`kA *' * ** ** *A *;*
0e, r 1 pt i 0.n ,Amount
IIUTLDTNG EiCINI1 /DtPOS :1T 2,750;00 .
Motk ** ** * * * *�. a *A **## * *ak's• **h#* * #* * *A* * *?h ** * * *** * * * ** *CA *
.1'ITY OF TW(WILa, NA 1 • 1L,, fRAt4SMIf
A,Aikk * * *A'h * *A *. # *),'it:At4 *IA *tt'•k *#k iv: •A'rt'*: .h .A•A*0i 11,.1I•. * * * *i, * *•A.4 4• 7,vir *•A*A **
10ti#314IT' Numaert .Ri70067t5 Amount : P ib6. ;30 11./A.6/9.7 11;.10.
ayitien :Mathad' ::CHECK Plntatiar�: 14.1 :ANDER ;ON
In•it: aH
Permit :t4a: .N197-0143 .. Type M1•rSLPERM MISCELLANEOUS Pt.KMl:,1"
Parco,l• Na :; 017900 -0320
Site 'Address: '4,304 S 1'24 ST.
.This Payment
. Total Beer:
T.ata1: ALL ',Mts.:
Balance:
kit•*��k *., *A.ft# Ask* ' * *tl•#• * *tic•A�1 * * **•01 *; * * #1 A�• �+ . *A #�1 * *.tla4 **'�• * * *k # *�:.A #*
Actount,Cad•e
000 "3122 ..100
000/316,.904'
;'4p ?. /342,0
esCriptjan
BUILDING N0N1ES'.
STATE HUILL)IUG SURCHARGE
INSF' .♦ E SME.MS
G60
:.00
AmgUnt
4.50
20.99
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
PERMIT'NO.
(206) 431 73670
Project:
�lndersoh
Type of inspection:
4jt@ sewer wAfermeter Pit.)-6
Address: 4304 1 304
S ' 29 th,
/
Date called:' 1_7_97
Special instructions:
Date wanted: a`my
! —%O — 97 p.m.
Requester: Kim artd er5 ors
Phono No.: 7i/ 1 3601 pager
1 Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
$S5
/10/a-7
pc.4.4.6542eLtt /
Alba 1-q?'
Inspector:
I— I
Date: IV p/�
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
I SPECTION NO,
INSPECTION RECORD.. -�
�
.Retain a copy with permL,
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
r P7 ofq
PERMIT NO.
431 -3670
Project: /'
_lam
jpe of inspectio �
Address :�L
�c ? L
called //` 7 r 93
Date wanted : / c 7
/ ,
m.
Special In tructions:
F'
Requester:
...,,-•
P & tie -- a I
Approved per applicable codes. Corrections required prior to approval.
CO M ET-Si-
1 Inspector: _.-
)\J
Date:
it
r 1 $42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Agency Case No.
9700783
A. Project Type: 11.
'ET SOUND AMR POLLUTION CONTRO 3ENCY
110 Union Street, Suite 500. Seattle. WA 98101 -2038
NOTICE OF INTENT
TO PERFORM:
Date Received
PAP/l3, OCT 21 1997
Agency Use Only
Asbestos Removal 12. Asbestos Removal & Demolition
. t►. Demolition. No Asbestos Removal
B. Property
Owner:
Property Owner's
Mailing Address:
City:
Phone: (39tx.0
State:
9q9
Zip:
C. Asbestos
Contractor:
Mailing Address: 7 30 4-/
PLEASE PRINT CLEARLY, THIS WILL
�
) Q /�
. _ 0 • 1.�1-1
BE YOUR RETURN MAILING LABEL
_ Contractor
Owner /CEO: `f
z •
,5
Phone: 1.0)'7('.3'7' '7 5
Contractor
Job No.:
Citv7 ,i.4
I State: L3T/
Zia: IV '2 g
Fax: (, )
3. ❑ 10 - 259 linear feet or 48 - 159 square feet (see back of form Airs)
Misc. Mat'I: 1 ❑ Cement Bd. ❑ Cement Pipe ❑ Flooring Mat'l ❑ Roofing Mat'I 1 Other. .
$150
p
4. ❑ 260 - 999 linear feet or 160 - 4,999 sauare feet H, 1j CC
D. Site /�
Address: G�I / L/
. I •.) L'
City ,j .O; //i
9
State: I
$750
1 Zip: / 711
Project Manager or // 11 f
Contact Person: 0? -71 nr" kll L'Y+ A -y-1- it �0) ( Phone: (�0(0) 71„--7.2)e-Y.
E. , Asbestos Survey or I No. of
❑ Mat'I Presumed: Structures:
Date Survey was
Conducted:
AHERA Building ,., AHERA SURVEY 1S REQUIRED BEFORE ALL DEVOUT ION PROTECTS
Inspector Name: / G
F. Demolition
Information:
Demolition
Contractor:
Was Asbestos Found? ❑Yes
If No, Attach Survey
Cern tc' io5o.:
oin `B 1 O 1 DEape: )Q n
No. of Start ❑ Training Fire (List Fire Dept. as demolition contractor below)
Sructures: / Date: % /1) 51 ❑ Ordered Demolition (attach copy of Order)
PRINT NAME HERE. YTER MAIUNG ADDRESS( BOX 1 O,G BA K IF TRAINING BURN ENTER FIRE DEPT. HERE I L i Li/ 4- ; r )) /! �r�-o ✓ �i f ))- Phone: (, (.0)
G. Asbestos Project
Information:
No. of Structures:
(see back if> 1) )/1
Start
Date:
Completion Wk. Days: M T W Th F Sa Su
Date: I Hours:
Total Quantity to be Removed: Linear Ft. Square Ft.
Will all asbestos material be
removed by oroiect completion?
❑ Yes
❑ No
Thermal System Insulation: ❑ Boiler1.Furnace Ins. ❑ Duct Ins. ❑ Pipe Ins. 1 Other.
10 Days
Surfacing Mat'l: ❑ Fireproofing ❑ Paints ❑ Plaster ❑ Textured Coatings Other.
3. ❑ 10 - 259 linear feet or 48 - 159 square feet (see back of form Airs)
Misc. Mat'I: 1 ❑ Cement Bd. ❑ Cement Pipe ❑ Flooring Mat'l ❑ Roofing Mat'I 1 Other. .
$150
H. Asbestos/Demolition Project Categories:
1. ❑ Owner - Occupied Residential Asbestos Removal Project
Owner - Occupied Residential Asbestos Removal & Demolition Project
Owner - Occuoied Residential Demolition Project. No Asbestos Removal
Notification Waiting
laroiect Fee
Period
NON - REFUNDABLE
Prior Notice
$25
2. All Other Demolitions With No Asbestos Removal Project
10 Days
$150
3. ❑ 10 - 259 linear feet or 48 - 159 square feet (see back of form Airs)
3 Days
$150
p
4. ❑ 260 - 999 linear feet or 160 - 4,999 sauare feet H, 1j CC
10 Days
$300
5. II 1.000 - 9,999 linear feet or 5.000 - 49,999 square fAsouN
10 Days
$750
6. ❑ 10.000 - 49,999 linear feet or 50,000 - 99,999 squetn
10 Days
52.000
❑
55.000
7. 50.000 - 99.999 linear feet or 100,000 - 149,999 $ lfat' t'
10 Days
8. ❑ 100.000+ linear feet or 150,000+ sauare feet RCPT. NO.. 'q 7 r
10 Days
510.000
9. ❑ Emergency Asbestos Proiect or Ca Emergency Demolition Proiect
Prior Notice
Twice Proiect Fee
10. ❑ Alternate Means of Compliance for friable materials or ❑ Demolitions
10 -Dav Review Period
Twice Proiect Fee
11. ❑ Alternate Means of Compliance for nonfriable asbestos materials
1 Concurrent with Proiect
Twice Proiect Fee
I. 1 do hereby certify that the information contained in this notification. and supplemental data described heroin. is to the best of my knowledge
accurate and complete. 1 shall not cause or allow any asbestos project or demolition activities to begin until the appropriate waiting period has
elapsed.
Ct-2Z/Azixt.$) 4,41Y17•0 /0A0
Completeness Review •
Performed By:
The Pu!_et Sound Air Pollution Control Agency (PSAPCA) is the local air pollution authority for Snohomish. King. Pierce ano
Kitsap Counties. PSAPCA's Regulatic" '11. Article 4. requires advance notification submitted to PSAPCA, on Agency -
approved form no. 66 -160 (Revised 10/�%., ,. for any asbestos project involving materiai. jual to or greater in size than 10 linear
feet or 43 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 returned copy will be your
valid notification.
. • • V
1 • • • 11 •
• 1. .•.' •11.1 • • y•
1a to •
J. Demolition
Contractor: _
,'j-, .la, N.. L uL IJL .
d- J <' iz jacce. be
/ �(j j. L
...•I.••• .au-
y SQkT
Owner /CEO:
(ailing Address:L�
6-6.. ,
Phone: �
bx
%�j3 • �3Ll
Contractor's
Job 4:
City: / 1.LK i.c) i )
State: tO Ar
I Zip: / J / -7 q
Fax: ( )
GUIDELINES FOR SUBMITTING AN ASBESTOS /DEMOLITION NOTIFICATION
Box A. Check the appropriate project type.
Box B. Enter the legal property owner information. For Owner - Occupied Residential Removal Projects (category #l) where
the property owner's mailing address differs from the site address. a letter must be submitted explaining why the addresses are
di fferent.
Box C. Enter the asbestos contractor and mailing address or other properly trained company or person performing the
asbestos project. Contact the Washington State Dept. of Labor & Industries or OSHA for worker training/certification
requirements.
Box D. Enter the project site address for the asbestos project or demolition. include a designated project manager or contact
person.
Box E. Check asbestos survey or material presumed. If asbestos survey is checked, fill out all information requested. All
demolition with or without an asbestos removal must have an asbestos survey performed by an AHERA Building Inspector.
Demolition with no asbestos discovered in the survey must submit a copy of the survey along with the notification. Asbestos
removal projects only may check the material presumed box if all materials are to be removed and disposed of as asbestos -
containing materials in accordance with PSAPCA Regulation III. Article 4.
Box F. Enter the demolition project information. If the structure is to be used in a training fire. list the fire department
responsible for conducting the burn as the demolition contractor in box J. If the property owner has been ordered to perform a
demolition by government official. submit a copy of the order from the appropriate official.
Box G. Enter all asbestos project information requested. All multiple structure asbestos project notifications must be
submitted with a work plan including a map of the area. site address for each structure. type and amount of asbestos in each
structure, and a detailed work schedule.
Box H. Check one project category in boxes #i -8. The project fee includes the demolition fee. Asbestos removal projects
and demolition 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 -9 and
then checking the applicable emergency box 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,offcial or a licensed structural engineer documenting that the structure is
in imminent danger of collapse. To request an alternative means of compliance for friable or nonfriable materials. check the
appropriate job size category in addition to tfie a Tplica6ie box ni categories 410 and #1 l. A work planmust be submitted by an
appropriately trained. individual along with the notification:— `' •''
Box I. Sign the notification certifying the accuracy and completeness of the information provided on the form.
Box J. Enter demolition contractor mailing information (on back).
Mandatory arntudmentj 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 S50.00 processing fee is required for all other amendments.
For technical assistance. contact Tom Hudson at (206) 689 -4053. Larry Vaughn (206') 689 -4035 or Kwame Agyei (206) 689-
4054. For inquiries concerning notification and amendment status contact Anne Morgan (206) 639 -4090.
PACIFIC RIM ENVIRONMENTAL, INC.
GOOD FAITH ASBESTOS SURVEY
RESIDENCE
4304 SOUTH 124TH STREET
TUKWILA, WA 98178
PERFORMED FOR:
JOEL ANDERSON
4304 SOUTH 124TH STREET
TUKWILA, WA 98178
ELANIE BR
AHERA CERTIFICATION #J &J961005 -BIR01
(EXPIRATION DATE: OCTOBER 5, 1997)
PACIFIC RIM ENVIRONMENTAL, INC.
6510 SOUTHCENTER BOULEVARD
TUKWILA, WA 98188
PRE #: 11282
DATE PREPARED: 06/26/97 PERMIT CENTER
RECEIVED
CITY OF TUKWILA
1 h
BLE ,OF CONTENTS
SECTION NAME NUMBER OF PAGES
1.0. SURVEY NARRATIVE 2
2:0 SAMPLE SUMMARY I
3.0 GOOD FAITH SIGN -OFF FORM I
4.0 PI:M ANALYSIS REPORT (S) 5
5.0.. :INSPECTOR CERTIFICATIONS .. 1
PACIFIC RIM ENVIRONMENTAL, INC.
1.0 SURVEY NARRATIVE
On May 31``, 1997 Melanie Bryce of Pacific Rim Environmental Inc., conducted an Asbestos
Survey in the residence located at 4304 South 124t1i Street; Tukwila, WA 98178. The survey was
intended to identify any possible asbestos - containing materials which may be disturbed during
demolition, remodeling or maintenance activities and to maintain compliance with WAC 296 -62-
07707. It should be noted that good faith surveys are limited in scope by nature and that those
materials which required destructive means to access or sample (i.e., within walls or above
enclosed ceiling areas) are not included in this report.
Asbestos - Containing Materials Summary
Thermal Systems Insulation (TSI)
No asbestos - containing TSI materials were identified during this survey.
Surfacing Materials
No asbestos - containing surfacing materials were identified during this survey.
Flooring Materials
No asbestos - containing flooring materials were identified during this survey.
Ceiling Materials
No asbestos - containing ceiling materials were identified during this survey.
Roofing Materials
No asbestos - containing roofing materials were identified during this survey.
Other Miscellaneous Materials
Material
Window Putty
Areas Found
Exterior, Southwest Window
06/26/97
PRE# 11282
Asbestos Sample Summary
Project Name: Anderson Residence
PRE Project ID:
11282
S m le # Sa le Loc ti
AHERA to or S 1 Degcri ti n
Athol T
!'
01 Back Bedroom
02 Back Entrance by Laundry Room
03 Kitchen
04 Bathroom
03 Living Room
06 Living Room
07 Kitchen
08 Living Room
09 Kitchen Counter
10 Roof Above Porch
11 Exterior, under Aluminum Siding
12 SW Window (only).
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Surfacing
Miscellaneous
Miscellaneous
Surfacing
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Thursday, June 26, 1997
Blue/Grey/Yellow Rectangle Pattern Sheet
Vinyl (Linoleum)
Wood Grained Rectangular Pattern Sheet Vinyl
White Square Patterned Sheet Vinyl
White Square Pattern with Blue Streaks Sheet
Vinyl
White Coiling Texture
Shcclrock
Shcetrock
Patch Mud on Shectrock
White with Gold Specks Formica
Black Asphaltic Roofing Shingles
Brown Paper
Window Putty
None Detected
None Detected
None Detected
None Detected
None Detected
None Detected
None Detected
None Detected
None Detected
None Detected
None Detected
Chrysotile 3•5%
N/A
N/A
N/A
N/A
N/A
N/A '.
N/A ..
N /A..
N/A
N/A ,..
N /A'
8 Linear Feet
PACIFIC RIM ENVIRONMENTAL, INC
STATEMENT OF COMPLIANCE WITH GOOD FAITH INSPECTION
In accordance with W.A.C. 296 -62 -07707 Pacific Rim Environmental, Inc. performed a Good Faith
Inspection of the area listed below for Joel Anderson and determined that asbestos is present in the
structure. Abatement of this material is the responsibility of a certified asbestos abatement contractor.
During the performance of your work, it is not anticipated that you will disturb asbestos - containing
materials, however should you or your personnel encounter any suspect asbestos containing materials it is
your responsibility to:
1) Contact a representative of the owner.
2) Consult the inspection report to determine whether or not the suspect material contains
asbestos.
3) Ensure that all subcontractors are informed and advised of the location and type of materials
that contain asbestos.
LOCATION: Residence
4304 South 12411' Street; Tukwila, WA 98188
AREA OF INSPECTION: See Survey for More Detail
ASBESTOS - CONTAINING MATERIALS:
1) Window Putty
I Hereby Attest:
The inspection report has been made available to me. I will inform all subcontractors of the location and
types of materials containing asbestos. I am authorized to sign on behalf of my company.
Contractor: Joel Anderson
Signature: Signature:
Print Name: Print Name:
Title: Title:
Date: Date:
06/26/97
PRE# 11282
PRECISION
ENVIRONMENTAL
SERVICES, INC.
BULK SAMPLE ANALYSIS REPORT
CLIENT: Joel Anderson
4304 South 124th Street
Tukwila, WA 98178
NVLAP Accredited
LAB #101631
PAT #11567
PRE #:
Report #:
Report Date:
Date Received:
Date Analyzed:
Page :
Analyst:
11282
697025
06/05/97
06/02/97
06/04/97
1 of 3
Fred Golloway
Attached are the results of analysis of 10 bulk samples submitted for asbestos identification,
lab ID #697025 through #697034.
Samples were analyzed in accordance with method EPA- 600/M4 -82 -020: "Interim Method for
the Determination of Asbestos in Bulk Samples ".
Each sample was initially examined under a Nikon SMZ - 2T stereoscopic microscope at a
magnification of 10X to 50X. Fibrous material was examined for morphology and content.
Representative fibers from each sample were immersed in a fluid with a known refractive
index. The specimens were examined under polarized Tight using a Nikon Labophot
microscope with a McCrone Dispersion Staining objective under 100X magnification. Optical
characteristics of the fibrous material were examined to determine the mineralogy of the
fiber. The observed optical characteristics include angles of extinction, sign of elongation
and refractive indices.
Separate layers of inhomogeneous samples were analyzed and reported separately. Unless
otherwise stated, asbestos content was quantified by calibrated visual estimation (CVES).
Samples in which asbestos was not observed were reported "none detected ".
The samples analyzed in this report were provided by third parties not subject to control by
PRECISION ENVIRONMENTAL SERVICES (PES). Consequently, the results presented
represent microscopic examinations in PES laboratory facilities and PES makes no
representation at to sample collection techniques or procedures. Test results pertain only to
the samples submitted for analysis.
This report can not be represented by the client to claim product endorsement by NVLAP or
any agency of the U.S. Government.
This report shall not be reproduced except in full without written permission o,ie laboratory.
Samples submitted by: Third Party Reports reviewed by:
Approved Signatory
PRECISION ENVIRONMENTAL SERVICES, INC.
BULK SAMPLE ANALYSIS REPORT
CLIENT: Joel Anderson
4304 South 124th Street
Tukwila, WA 98178
PRE #:
Report #:
Report Date:
Date Received:
Date Analyzed:
Page :
Analyst:
11282
697025
06/05/97
06/02/97
06/04/97
2 of 3
Fred Golioway
Client/Lab
Number
Sample Location and Description
Asbestos Type / %
Other Material
11282 -01
Yellow, black, and gray -brown sheer
None Detected
Cellulose (50 -55 %),
697025
vinyl with black fibrous backing and
red mastic.
Vinyl, Tar, Adhesive
11282 -02
Brown, wood grained sheet vinyl with
None Detected
Cellulose (15 -20 %),
697026
Tight brown, fibrous backing and
brown mastic.
Fiberglass (1 -3 %),
Vinyl, Binder,
Adhesive
11282 -03
White sheet vinyl with light brown,
None Detected
Cellulose (10 -15 %),
697027
fibrous backing and brown mastic.
Fiberglass (<1%),
Synthetics (1 -3 %),
Vinyl, Binder,
Adhesive
11282 -04
White sheet vinyl with light brown
None Detected
Cellulose (10 -15 %),
697028
fibrous backing and black mastic
splotch.
Fiberglass ( <1 %),
Synthetics (1 -3 %),
Vinyl, Binder,
Adhesive
11282 -05
Beige, white, green and silver paint
None Detected
Cellulose (5 -10 %),
697029
layers on brown paper.
Paint
11282 -06
Light brown, chalky sheetrock with
None Detected
Cellulose (15 -20 %),
697030
beige - painted, light brown brittle mud
and blue fibrous mesh layer.
Fiberglass (1 -3 %),.
Gypsum, Binder,
Paint
11282 -07
Light brown, chalky sheetrock with
Chrysotile <1 %
Cellulose (25 -30 %),
697031
light brown brittle mud and white and
green paint layers.
Gypsum, Binder,
Paint
PRECISION ENVIRONMENTAL SERVICES, INC.
BULK SAMPLE ANALYSIS REPORT"
CLIENT: Joel Anderson
4304 South 124th Street
Tukwila, WA 98178
PRE #:
Report #:
Report Date:
Date Received:
Date Analyzed:
Page :
Analyst:
11282
697025
06/05/97
06/02/97
06/04/97
3 of 3
Fred Goiloway
Client/Lab
Number
Sample Location and Description
Asbestos Type / %
Other Material
11282 -08
White brittle, white - painted sheetrock
None Detected
Cellulose (25 -30 %),
697032
patch mud with white paper.
Binder, Paint
11282 -09
White and Tight brown counter top
None Detected
Cellulose (20 -25 %),
697033
material with gold flecks, brown
fibrous layer and brown mastic.
Binder, Adhesive,
Foil
11282 -10
Black asphalt shingle material with
None Detected
Cellulose (15 -20 %),
697034
brown gravel.
Tar, Mineral
Aggregate
PRECISION
ENVIRONMENTAL
SERVICES, INC.
BULK SAMPLE ANALYSIS REPORT
' NVLAP Accredited
LAB #101631
PAT #11567
CLIENT: Joel Anderson PRE #:
4304 South 124`h Street Report #:
Tukwila, WA 98178
Report Date:
Date Received:
Date Analyzed:
Page :
Analyst:
11282
697258
06/13/97
06/10/97
06/12/97
1 of 2
Fred Golloway
Attached are the results of analysis of 2 bulk samples submitted for asbestos identification,
lab ID #697258 through #697259.
Samples were analyzed in accordance with method EPA- 600/M4 -82 -020: "Interim Method for
the Determination of Asbestos in Bulk Samples ".
Each sample was initially examined under a Nikon SMZ - 2T stereoscopic microscope at a
• magnification of 10X to 50X. Fibrous material was examined for morphology and content.
Representative fibers from each sample were immersed in a fluid with a known refractive
index. The specimens were examined under polarized light using a Nikon Labophot
microscope with a McCrone Dispersion Staining objective under 100X magnification. Optical
characteristics of the fibrous material were examined to determine the mineralogy of the
fiber. The observed optical characteristics include angles of extinction, sign of elongation
and refractive indices.
Separate layers of inhomogeneous samples were analyzed and reported separately. Unless
otherwise stated, asbestos content was quantified by calibrated visual estimation (CVES).
Samples in which asbestos was not observed were reported "none detected ".
The samples analyzed in this report were provided by third parties not subject to control by
PRECISION ENVIRONMENTAL SERVICES (PES). Consequently, the results presented
represent microscopic examinations in PES laboratory facilities and PES makes no
representation at to sample collection techniques or procedures. Test results pertain only to
the samples submitted for analysis.
This report can not be represented by the client to claim product endorsement by NVLAP or
any agency of the U.S. Government.
This report shall not be reproduced except in full without written permission of the laboratory.
Samples submitted by: Third Party Reports reviewed by:
Approved Signatory
PRECISION ENVIRONMENTAL SERVICES, INC.
BULK SAMPLE ANALYSIS REPORT
CLIENT: Joel Anderson
4304 South 124t Street
Tukwila, WA 98178
PRE #:
Report #:
Report Date:
Date Received:
Date Analyzed:
Page :
Analyst:
11282
697258
06/13/97
06/10/97
06/12/97
2 of 2
Fred Golloway
Client/Lab
Number
Sample Location
and Descri • tion
Asbestos
T •e/%
Other Material
11282 -11
Under Aluminum Siding:
None Detected
Cellulose (40 -45 %),
697258
Brown paper with aluminum foil layer.
•
Aluminum Foil,
Binder
11282 -12
SW Window:
Chrysotile 3 -5%
Cellulose (<1%),
697259
Light gray, soft, white - painted window
putty.
Mineral Aggregate,
Binder, Paint
Cer1t/ca1e o� 7rainin9
J &J Associates is pleased to certify that
Melanie R. Bryce
has attended and successfully completed the
AHERA BUILDING INSPECTOR REFRESHER
in accordance with
40 CFR Part 763, Subpart E, Appendix C
on this 5th day of October, 1996
at Tukwila, Washington
Valid through October 5, 1997
J &J961005 -BIR 01
ACCREDITATION NO.
J &J ASSOCIATES
550 NW Fairwood Way
Bremerton, Washington 98311
(360) 731 -6015
If ° l. ; (off� : r p • 0 V l `f tT'P( p 4 �t 1i ,, ,T f1 rt1
t
y `''•' + .• l;
•..'n , S. ;G �t•w, ��i
',Lil•S.�dtilZ 1!�ii�cto:.M,y� •Mr,I•,.;.e�ty' n1.�,i� Jp:.. y,�ri...i':r`.,:«....ilf,': +ttie!:�r,2��..'���;W
City of Tukwila
John W. Rants, Mayor
Department of Community Development
MEMORANDUM
LAURIE ANDERSON, FINANCE
WENDY BULL, PERMIT CENTER
DATE: NOVEMBER 13, 1997
SUBJECT: RELEASE BOND /DEPOSIT
Steve Lancaster, Director
Please release the $2,750 bond /deposit to JOEL AND KIM ANDERSON. The
demolition work was signed off by the building inspector on NOVEMBER
10, 1997. The original transaction was NOVEMBER 6, 1997, Receipt #5842
for $2,750.00. PERMIT NO. MI97 -0143.
Please return the check to me and the applicant will pick it up at the permit
center.
Thank youl
•
•
".�: �.
•
CITY OF TUKWILA
TREASURER'S CHECK
6200 SOUTHCENTER BLVD. PH. 206- 433 -1800
TUKWILA, WA 98188
oca, )11147
BANK
TUKWILA•ANOOVER PARK BRANCH
1S1 ANDOVER PARK E. P.O. BOX BB923
SEATTLE. WASHINGTON 98186.0983
ANK1 J WABHINGTO .NATION L ASSOCIATION
7
19 -10 30
1250
$ :,7S 00 7
Onie 1Si ® .
CITY OF TUKWILA
TO:
FROM:
DATE:
SUBJECT:
City of Tukwila
John W. Rants, Mayor
Department of Public Works
NOTIFICATION OF UTILITY PERMIT ACTION
Permit Center
Public Works Engineering
August 28, 1997
Anderson Existing SFR
Demolition of Existing SFR
4304 South 124th Street
Permit No.: MI97 -0143
Contact Person: Joel Anderson
Phone: (206) 763 -7349
Ross A. Eamst, P. E., Director
THE FOLLOWING PUBLIC WORKS PERMITS HAVE BEEN APPROVED FOR ISSUANCE
IN ACCORDANCE WITH THE PLANS APPROVED ON AUGUST 28, 1997:
Water Service Cap
Sanitary Side Sewer /Septic Abandonment
PERMIT FEE
No Fee
$20.00
TOTAL: $20.00
Two copies of the confirmed Utility Permit Application and plans are attached for inclusion in the
permit file.
JJS /sal
CF: Development File (with copy of application and plans)
PW Utilities Inspector (with copy of application and plans)
Finance Department (with a copy of application)
mriumewmallIn
P4Ytctk' (o4trt&4 C'.aP,y
PLAN REVIEW / ROUTING SLIP
ACTIVI'T'Y NUMBER MI97 -0143
PROJECT NAME ANDERSON JOEL & KIM
DEPARTMENT:
B'tKLDING DIVISION PREVENTION
P�((��,, t Cl)91c0 -1 � d (a(q7
UBLIC WORKS ,�] STRUCTURAL
WVc47 M�
DATE 8/22/97
PLANNING DIVISION
jf Slay /y-y
PERMIT COORDINATOR .
amossimmoNswisasilMagi
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE 8/26/97
COMPLETE (ZI
COMMENTS •
NOT COMPLETE p NOT APPLICABLE El
TUES /THURS ROUTING: PLEASE ROUTE C NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF Cl (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS: (ten days)
DUE DATE 9/09/97
APPROVED ! 1 APPROVED W/ CONDITIONS C NOT APPROVED (attach comments) E
REVIEWERS INITIAL
DATE
CORRECTION DETERMINATION:
APPROVED n APPROVED W/ CONDITIONS
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) U
t b3,70,f. "r4 "i't ociitlI VrA -A.' ri icS,rii xl
fi tr „?:?WI�'.MS"%�h”
PLAN REV 1 HW /ROUTING SLIP
ACTIVITY NUMBER M197 -0143
PROJECT NAME ANDERSON JOEL & KIM
DATE 8/22/97
DEPARTMENT:
BUILDING DIVISION u
PUBLIC WORKS
L
FIRE PREVENTION ( PLANNING DIVISION'
STRUCTURAL n .PERMIT COORDINATOR E
DETEPJVDNATION OF COMPLETENESS: (T,Th)
COMPLETE
COMMENTS '
NOT COMPLETE
DUE DATE 8/26/97
NOT APPLICABLE fl
TUES /THURS ROUTING: PLEASE ROUTE
•
NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
ff
DA
'I'E -z(DiCt-7
APPROVALS OR CORRECTIONS: (ten days)
APPROVED
DUE DATE 9/09/97
APPROVED W/ CONDITIONS ,J. NOT APPROVED (attach comments)
DATE 5,(-76141-)
REVIEWERS INITIAL
CORRECTION DETERMINATION:
APPROVED C APPROVED W/ CONDITIONS
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) Q
•
ii��' •;,W,� %�.�' r i l: "7i "IYAtV 4`a Ci�i v�ru�
1 t C,f6n�F? 1 ?x3 1 1i'P1 iiriC`:iS:e Ill I
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER 14197 -0143 DATE 8/22/97
PROJECT NAME ANDERSON JOEL & KIM
DEPARTMENT:
BUILDING DIVISION FIRE PREVENTION �--1 PLANNING DIVISION'
PUBLIC WORKS r STRUCTURAL C •PERMIT COORDINATOR Q
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE 8/26/97
COMPLETE
COMMENTS
NOT COMPLETE
NOT APPLICABLE El
TUES /TH JRS ROUTING: PLEASE ROUTE Y• NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF (If routed b staff, make copy to master file do enter Sierra.)
REVIEWERS INITIAL DATE 67:20,?'
t
APPROVALS OR CORRECTIONS: (ten days)
APPROVED l l
APPROVED W/ CONDITIONS Cg*
CORREC'T'ION DETERMINATION:
APPROVED.
REVIEWERS INITIAL
DUE DATE 9/09/97
NOT APPROVED (attach comments) 11
APPROVED W/ CONDITIONS
DATE
DUE DATE
NOT APPROVED (attach comments)
; ?- :ttrx, ,Tki t, t� h °C -Y ik'm: ` iF;;},*', tsk�h';r
�...... . {+ti,,• ",• .r � , a !'{� ti;
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER )1197 -0143
PROJECT NAME ANDERSON JOEL & KIM
DATE 8/22/97
DEPARTMENT:
BUILDING DIVISION T FIRE PREVENTION PLANNING DIVISION'
PUBLIC WORKS a STRUCTURAL PERMIT COORDINATOR Q
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE
COMMENTS '
NOT COMPLETE
DUE DATE 8 /26/97
NOT APPLICABLE -Er
TUES /TIIURS ROUTING: PLEASE ROUTE NO FURTHER REVIEW REQUIRED-Er-
ROUTED BY STAFF C (If routed by staff, make copy to master File do enter Sierra.)
REVIEWERS INITIAL
DATE
2,6/47
APPROVALS OR CORRECTIONS: (ten days)
APPROVED n APPROVED WI CONDITIONS
REVIEWERS INITIAL
DATE
DUE DATE 9/09/97
NOT APPROVED (attach comments) u
CORRECTION DETERMINATION:
APPROVED F-7 APPROVED W/ CONDITIONS
REVIEWERS rNrrIAI,
DATE
DUE DATE
NOT APPROVED (attach comments) Q
;. +> r., ir,M�. � �±tjY.,7t t.t iPrM � °; { "..'•1K a "`=�i � «�:.3�` �"- .s.fr,,.,,..',-,,
tCr ?;.'�.'�'virp Y eigic ^ieS:63, , vx ?: F u7;'t; ?i"�''a ".t? Uzi t�j : �;tr.': Cad s. -Att alb_. ",5f' :ir . l s. i!'f ? G' �?r" c fix• x ,v r:. tt:, 0.� { ? �. r'ku ..
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER MI97 -0143
PROJECT NAME ANDERSON JOEL & KIM
DATE _._ 8/22/97
DEPARTMENT:
BUILDING DIVISION Li
PUBLIC WORKS L.
FIRE PREVENTION
STRUCTURAL
C
PLANNING DIVISION' •
PERMIT COORDINATOR Ej
1
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE E
COMMENTS
NOT COMPLETE
DUE DATE 8/26/97
NOT APPLICABLE Eff
TUES /TBJJRS ROUTING: PLEASE ROUTE
NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF n (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL 1t1V
DATE 8 JZ.(/ a
APPROVALS OR CORRECTIONS: (ten. days) DUE DATE 9/09/97
APPROVED n APPROVED WI CONDITIONS
REVIEWERS INITIAL
DATE
NOT APPROVED (attach comments) Li
CORRECTION DETERMINATION:
APPROVED n APPROVED W/ CONDITIONS
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) E