HomeMy WebLinkAboutPermit MI97-0198 - FAMILY FUN CENTER - FARMHOUSE AND BARN DEMOLITIONM1q17fte)11
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 IS PROCEEDING AT THEIR OWN RISK.
Parcel No: 242304 -9013
Address: 7140 GRADY WY S
Suite No:
Location:
Category: DEMO
Type: MISCPERM
Zoning:
Const Type: 645
Gas /Elec.:
Units: 001
Setbacks: North:
Water: TUKWILA
Wetlands:
Fire
.0 South: .0 East:
Sewer: TUKWILA
Slopes: Y
Contractor License No: PAULETE0082LA
Permit No:
Status:
Issued:
Expires:
Occupancy:
UBC:
Protection:
.0 West:
Streams:
MI97 -0198
ISSUED
11/18/1997
05/17/1998
DWELLING
1994
N/A
.0
OCCUPANT FAMILY FUN CENTER
15034 GRADY WY S, TUKWILA WA
OWNER NIELSEN JACOB
7170 S GRADY WAY, SEATTLE WA 98188
CONTACT CHANDLER STEVER Phone: 425 822 -0444
11820 NORTHUP WY #E -300, BELLEVUE WA 98005
CONTRACTOR PAULETTO TRUCKING & EXCAVATING Phone: 509 466 -4425
1818 W FRANCIS #240, SPOKANE WA 99205
k********************************************** k**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Description:
DEMOLITION OF 2,000 SF OLD FARMHOUSE AND THE
REMAINS OF THE BURNED DOWN BARN AND ABANDONMENT
OF EXISTING SEPTIC TANK SYSTEM.
kk*************************************************** * * * * * * * * * * * *k * * * * * * * *k * * * * * * **
Construction Valuation: $ 8,333.34
PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: JJS
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: N No:
Sewer Main Extension: N Private: Public:
Storm Drainage: N
Street Use: N
Water Main Extension: N Private: Public:
k*************************************************** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * **
TOTAL DEVELOPMENT PERMIT FEES: $ 46.50
k******************* * * * * * * * *k * * * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * *•k * * * * * * * * * * *•k * * * **
Permit Center Authorized Signature:_
'z oate:a-A-17--
I hereby certify that I have read and examin-• 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.
Signature:
Date:/,
Print Name:
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.
..e.u:ys•�.alast .'1410 CtSb.lcf
Address: 7140 :GRADY WY
suite.
Tenant:
Type MISCPERM
ParL e;1 #: 242,304-9013,
Status: ISSUED
Applied: 11/03/1997
Issued: 11/18/1997
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Permit Conditions:
1 No changes will be made to scope of . word: unless. approved by
Tukwila Building Division
All • permits, . inspection "%ec,ord:.,t aril approved plans shall
available at the job,,s.ite prior to the Start, 0t.anv� con -
struction. , There •documents are to ::be maintained and avail-
able until f inal i'nspection'; approva.r . is gra,nted
3. Comply with the requFrenient's of'TMC 16.04, Demolition:/Reloc-
ation of S;truc`tures'an`d Article ;E7 .. of•. the Un:ifor;'m Fi''reCod' .
4. Remove ai10weeds, Concrete-, stone foundations, 'flat con
'crete,. concrete pat•ios,, masonry" walls, garage floor s, dr i"ve-
ways and similar;: structures and `a`11 ,loose mi,'c,el laneous
materi°`al'. ,Properly` cap sanitary sewer and water cotmec-
tions:; .,properly fill or ,otherwise. protect all basements,
cellaits, septic _tanks," .we lls and other excavations
;. EXISTING'i`TREES CANNOT-BE REMOVED WITH THIS PERMIT.
6. Tempat�ar y, er;osi`on control`. measures. .shall be implemented as
then,f,ir_t Girder o' busi "Hess to',prevent 'sedimentation: off,-
� } l
it,e,: :or intoo a,xi`st'inq t'�crm dra'inag,e aL1'1 i•.tle: .
7. ;The ',site sh'a 1 1 'i ave..p.errane,nt ero_ i on icon.tro 1 measures.
pl e. as s,00n`ras i.?o.sible::.after final;" "grading has been,,,:,
con.p,,l;eted .and�..prio.rr:.tdi thei Final Inspection.
B, ALL '`L QN'�TRUCTI')N 'ACTIVITY' AS',ci'CIATECJ•::WI;TH . THI': DEMOLITION',,
SHAL ?,BE: ���I'MITED TO `WITHIN 10' 'OF -THE''BU`ILDING EXTERIOR,.
Any'septic`�tt,anb s in the area shal 1 be pumped "empty ,and
reuro�v�e,d or,, Oiled with sand. A copy .o,t , docume`ntat,i`on. t'r' m .
the b;u,s;iness .that performed the pumping , sha 11;.
' be <.,provi ded
to the : Ci ty,Ut i 1 i ti es Inspector -LEE: SANITATION .SERVICE,
IN
PLMPING :RECEIPTS
ARE ATTACHED AS ;,PART ,OF THIS PERMIT.
10. Va 1 i d i ty of Perm;l t, , The issuance of a 'permit or approval 'ot
plans, sOecJficatiOns, • and computation. shall not :be con
strued to be a emit. for , or,an approval of, anvviolat
ion.
of any of th.e:°provisions of the building code or of .any
other ordinance of the ,jur i`sd i,ct,1 on No permit presuming to
give authority to 'violate or cancel the provisi,on` of this
code shall be val'i'd;
CITY OF TUKWILA
Permit Center (
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
Miscellaneous Permit Application
Application and plans must be complete In order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
Project Name/Tenant: / / /� _
///' /-5X 1-2 /'71 4. `41 /t: /..C'JY ri.`.y /� :. .L.Lrt::^
Value of Constructjo
r;ii___ e 5, -35, -'. _3L
Site Address: C- City State /Zip:
7 /'/O ,.�o. /� !4rl4/ '`' ' /u / /�i ; /?�i�rs/ �Pi,t'S'
Tax Parcel Number:, i
, (-JR. QL4`CI0 1
Property Owner:
402,4 , nx,/, 4r ' fit' /r i' /. ..Jc.-
Phone: .
li /�' $ ' // _)
Street Address: City
State /Zip:
/ /S �: 1-�: Z4e'e .4 tic' � ('',,I,04.3 3 ([t 5),,<<y
Fax #:
6( :-, S i - 6 P?P
Contact Person: /
j)C/ /( i'p 'e
Phone _
4' 7 ,
Street Address: ,, Ci State /Zip:
// r .) ('.h;ft .s /�)�.? /<z• C,'' �'i i ('�.% /1 /14= /
Fax It;
(j, /! ...1 ' :, -4t7.':1
Contractor: �
igl i/' i4 , /L/f4('/A' ' f ,--',./..c (:-/ .'M /! (. 1,0
Phone:
... %) r' .. 6'.,6. .. C/V€.' ? -
Street Address: City State /Zip:
.t S/y F /sAc /3 7r2 ., -ok:;ne< X1.12.84 c7?,:-.1y
Fax #:
Architect: /,
/7l4L-14L.1//Aid( ,�'/.'Yk:•'f'Nrf' (C / ,qJi /;L .`_',f'<. /ng-
Phone:
`7/ J_. - Y;:..' '-C1t/Vf/
Street Address: City State /Zip:
/J'/0 h..'tiNll /r 46. r! E :�' /v, /�r, / // / / /R' 1/' '-4+n.t'
Fax 8:
/ / %. S•'' 22-5' l//
Engineer: .,
/i,14/1 /( A!f r"/.1 '/)/v /.1/1/.../7/6: /4)
Phone:
,V,' --,75%-G:.Z'--'-
Fax #:
�:�. S i - ,� 7 S Z.
Street Address: n� City State /Zip:
/p.f. / ;' 2' ! 4,'e ...'.4.' . /l /)n/ P 64.1 /rS „r 'Are 1.
i MISCELLANEOUS PERMIT REVIEW AND APPROVAL REQUESTED: (TO BE FILLED OUT BY APPLICANT)
Description of work to be done: Q', 00 0 51. ?Y»? hoc •{'.- , e- reimi »5
r •a4 . r”, (.'.A.. el . .5..7 :��i r e 7 [. i /::, a to,' x r1 eCi - / i t'/'
Will there be storage of flammable /combustible hazardous material in the building? ❑ yes pl no
Attach llst of materials and storage location on separate 8 1/2 X 11 paper IndicatingsFilities & Material Sa et) Data Sheets
Above Ground Tanks ❑ Antennas /Satellite Dishes ❑ Bulkhead /Docks Commercial Retool
❑,+ Demolition C3 Fence ❑ Mechanical to Manufactured Housing - Replacement only
nParking Lots ❑ Retaining Walls ❑ Temporary Pedestrian Protection /Exit Systems
❑ Temporary Facilities ❑ Tree Cutting
APPLICANT REQUEST. FOR MISCELLANEOUS PUBLIC WORKS PERMITS
❑ Channelization /Striping
❑ Flood Control Zone
❑ Landscape Irrigation
❑ Storm Drainage
❑ Water Meter /Exempt #
❑ Water Meter /Permanent #
❑ Water Meter Temp #
❑ Miscellaneous
❑ Curb cut/Access /Sidewalk ❑ Fire Loop /Hydrant (main to vault)#:._ Size(s):
❑ Land Altering: 0 Cut cubic yards 0 Fill cubic yards 0 sq. ft.grading/clearing
❑ Sanitary Side Sower #: ❑ Sewer Main Extension 0 Private 0 Public
❑ Street Use ❑ Water Main Extension 0 Private 0 Public
0 Deduct 0 Water Only
Size(s):
Size(s):
Size(s : Est. quantity: gal Schedule:
Moving Oversized Load/Hauling
MONTHLY SERVICE BILLINGS TO:
Name: /
t../4_,_,3
Phone:
City /State /Zip:
0 Water
0 Sewer
0 Metro 0 Standby
WATER METER DEPOSIT /REFUND BILLING:
Name:
Address:
Phone:
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:
' t 1 r 3 T1
Dale application expires: ^vnl
Appilca tar: (initials)
ALL MISCELLANEOUS PE • MIT APPLICATIONS MUST BE SUB ' ED WITH THE FOLLOWING:
ALL DRAWINGS SHALLJE 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.)
❑
SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR
PERMIT REVIEW
Submit checklist No: M -9
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
❑
Antennas /Satellite Dishes
Submit checklist No: M -1
0
Awnings /Canopies - No signage
Commercial Tenant Improvement
Permit
❑
Bulkhead/Dock
Submit checklist No M -10
❑
Commercial Reroof:
Submit checklist No: M -6
r
Demolition
Submit checklist No: M -3, M -3a.
❑
Fences - Over 6 feet in Height
Submit 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 No. M -8,
Residential only - H -6, H -16
❑
Miscellaneous Public Works Permits
Submit checklist No: H -9
❑
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 Wails - Over 4 feet in height
Submit checklist No: M -1
❑
Temporary Facilities
Submit checklist No: M -7
❑
Temporary Pedestrian 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:
SIgnatur
) /
,
Date: /41 ,..rk-;' '42'7
Print name•
vriN /1). rz,,{
u
n rEu _K.
Rhone' % .`.
iv ��c� J /s.a i c` ;5
,"/97
Address:
2
" S .0 C4,A e:; ;4Zic
City /Sate /Zip:
er� CCU . (720,-e i
MISCPMT.DOC 7/11/96
Kr r *i4ik**A*k+ ***•A•**•Ak•kAk•A*A(4A k k k :.• •tr• • * •k•k*•k:4•Ak•kk4 '
.TTY OF ' UKWILA, WA, I' 1� TRANSMIT
k' *kAk*/i*A * *Ak *AA *k* •kA *kk•k *i *4kk * *4 ** k A *1'ki1•klk4 A k •1 A*. A *474A
,TRANSMIT 'i umber R9 ?00 ;73 Amount: 46.50 .J_1 /03/97 16:3
'Payment Method„ CHECK Natation.. HUISH it ilLY FUN Init:. KOP
Permit Na: MI'�-•OV E3 - Type: MXSCPL "It14. MIbL LLANLOLJ9 PCItf4I'r
Paircel No: 242304,-90'63
9 j'te Addre'as: 15034 'BRADY 14Y 9
Total Fees„ 46.150
Payment A9 .50 Total E1LL Potts: 46.50
pa•Iance. .00
ki . * # *A.ir * * *k ** *.kA* *a "* * kA*** Ad**** A*. 1**** A * **.kok$ *,% **04,. * *:K *AA ***
Account Cod Dedciwi pt ion Amount
? 000/322.100 BUILDING. - NONRES 42.00
000/386.9.04 STATE DUILUING buRRCHARSE 4.50
INSPECTION RECOQD
Retain a copy with jd,_....nit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA -98f88
01
PERMIT NO.
206
31`3670
al Li
Mirlff,41
16,...iffiNA 1 if
Date called:
Ad •
itig
Spec al instructions:
f
Date wan : • i y
'..
a.m.
. m,
Requester:
Phone No.:
proved per applicable codes.
1 1
Corrections required prior to approval.
COMMENTS:
IInspector. Date: (72...0„....,67
_
1 $42.00 REINSPECT( FEE R QUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECT ON NO
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100; Tukwila, WA 98188
INSPECTION RECORD,_.,
Retain a copy with ‘H.
-Q fig
��..- PERMIT NO.
(206J 431 -3670
Vit,hyt'' k
`..7� n �Q nJ „r,
Type ctio1
() ()a
_ q
,' i
I
a.m.
P.m.
Ad tt4 0
,�+1 �
Date called:/ 1 1 r `_ Q
Special instructions: 7
Date wante ,^
Regt e; :c {< i
Phon No.:
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Inspector:
Date:
-?Jwic7
ri S42.00 REINSPECTION FEE REQUIRED. Prior to inspe tion, tee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECTION REC ,
Retain a copy with FIL,._,,,,.,i
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Vici IiN n
orkr
Type of i = t ' ,,.��...''s
Afilrts�t citc J
, `, , - 5
{',�/,r/
Date called �:
Date wants .m `
)dto??• ap.m.
Special instructions.(, //
Reryeve (6140tio .
Peel 9C/0— t 67/ _
71 Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
lit oh7
i/uv 621z4„.
f Inspector:
1 1
Date: 1 / f 57
$42.00 REINSPECTION FEE REQUIRED, Prior to Inspection, fen must
be paid at 6300 Southcenter Blvd., Suite 100, CaII to schedule reinspection.
•
INSPECTION
INSPECTION REC D
Refath a copy with it
NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
A1177- om
PERMIT NO,
(206) 431 -3670
Project:
' „A7 FA. ltz
Type of ins tion:
�
Date call d :
Address:
Special instructions: ._
Date wanted: ! `4...0o .47 42,
Requester:
Phone No.:
Approved per applicable codes.
Corrections required prior to approval.
/COMMENTS:
LInspector
Date: if'../5
$42.00 ,REINSPECTION FEE REQUIRED.. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
.,t
ti
PR0?
COA,ME4'11--
GgE04 RAVER
ndcr:..c1 t:; .: tho Plan Chcoir�Pt y/' n'a
_.
t c ror., and olrgssio c;�T4'
plan, does not
ac:Jotc
4p' // `0 —,/
/
// )/
// / "I
tsry
I. GT -11 '�-
�/
Approximate
of Soil Stoc
So,\
contractor's
arcel 2
•Concroto
Permit No.
Gras1b N
Bushes
co MONSTER R0A0
"'o.GCW -17
,•' J�5
r AT-6
� pc4 ,
Ecology
Blocks •
• /Various '
1011 Stains ; \)
Oil Dump'o •
oat 4. t/
4- 1" —i
i _ -_____ }`Shed I
J General
o I i 55— gallon
Drum
Lam_ Stcrago ----'�"
O'c�,�! Oil Staining
b
,,,ikaa r. -i
ouff
Barn
E54413.NE
----- I
-.� �••J
•
Heating
Heating
/Qa/
I� °/ �a..c°�
j`moo hoc
Ia �o,•
i - -e* GT -10
/
• 1 owdust /
1I Diesel ASTI�-'1 Sawdust
LT -7I 1 (Removed) S
/Box 1/ •�s,,' AST
Looking r� 1 ' GCT -0 Lop
/ Oil
OII UST Fill Pipe
Oil AST
Oil Stains
�1J
GB -1 4-
OCT -4
Slog
' AT -7
(Re
9c
[cores
di
RR
l I
a
• � Nursciy
Debris
Former
Nursery
Pa cel 3
F Tli;'IA
VED
NOV I71.
UNDEVELOPDI c.!
null Luc:
Garage
•
•
•
PERMIT ENTER
shown are approximate.
KCAL&
IWO
Geo Engineers
.141.1 1J, C s: /Li I I V
A) A j d 177;72 G..
/ /1 A1=1L A/ C4ii ♦i r)#- .f
Demolition, sites In relationship to existing
significant trees. DP, 11 -14 -97
KA
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5 133RD
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sour ;I 6400 AEU
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0
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SCALE IN FEET
Sv•O1H ST
ru
RECEIVED
CITY OF TUKWILA
NOV 031997
PERMIT CENTER
Reproduced with permission granted by THOMAS BROS. MAPS, This mop is copyrighted by THOMAS BROS. MAPS.
It is unlawful to copy or reproduce all or any port thereof, whether for personol use or resole, without permission.
N
Geot:!FnQineers
VICINITY MAP
•
City of Tukwila
John W Rants, Mayor
Department of Public Works
NOTIFICATION OF UTILITY PERMIT ACTION
TO: Permit Center
FROM: / // Public Works Engineering
DATE: November 13, 1997
SUBJECT: Huish Family Fun Center
7140 Grady Way South
Project No.: PRE96 -0037
Permit No.: MI97 -0198
Contact Person: Chandler Stever
Phone: (425) 822 -0444
Ross A. Eamst, P. E., Director
THE FOLLOWING PUBLIC WORKS PERMITS HAVE BEEN APPROVED FOR ISSUANCE
IN ACCORDANCE WITH THE PLANS APPROVED ON NOVEMBER 13,1997:
Septic Abandonment
PERMIT FEE
No Fee
Two copies of the confirmed Utility Permit Application and approved plans are attached for inclusion
in the permit file.
JJS /jh
CF: Development File (with copy of application and plans)
PW Utilities Inspector (with copy of application and plans)
Finance Department (with copy of application)
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: (206) 433 -0179 • Fax (206) 4313665
rio BkS
PERFORMANCE
ABATEMENT SERVICES
November 11, 1997
Huish Family Fun Center
1155 Graves Ave
El Cajon, CA 92021
fult 111.011.
3201 13th Avenue, S.W., Seattle, Washington 98134
Telephone: 206- 467 -8733 Fax: 206- 623 -2091
RE: 7100 — 7160 S. Grady Way
Tukwila, WA 98188
Dear Mr. Huish:
This letter has been prepared to report the results of our asbestos abatement work for
the above reference project. PAS started the project on Monday 11/3/97 and will
completed the project on 11/13/97. The abatement consisted of the removal of the
following asbestos materials:
• Multiple layers of floor sheeting and subfloor in upstairs and down stairs bathroom
and kitchen areas.
• Exterior transite panels and shingles.
• Heating duct insulation removed with duct.
• VAT floor tiles removed from corridors.
• Roofing materials identified in survey are to be removed by the demolition contractor
with onsite initial air monitoring by Pacific Rim Environmental (2060 244 -8965) and
verified with PRE.
• Air monitoring sampling for containment was performed by PAS and analyzed by by
Pacific Rim Environmental.
• PAS filed both Labor & Industry and PSAPCA (Case #9700812) permits (attached).
• ACM waste from the site has been double bagged, properly labeled, and is being
transported by NTSI to Waste Management's Facility.
The structures are ready for demolition, except for minor work on the former Dairy
Building (7170) which will be completed this week.
Sincere ,
PERF MANCE ABATEMENT SERVICES, INC.
aul Hanway
Project Manager
DRAf�Y�W'i
RECEIVED
CITY OF TUKWILA
NOV 1 21997
PERMIT CENTER
Department of Labor & Ind
300 W Harrison St
Seattle WA 98119-4081
Phone: (206) 281-5473
FAX: To Regional Offices
usties
72/0
NOTICE OF INTENT TO REMOVE OR
ENCAPSULATE ASBESTOS
THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 DAYS PRIOR TO THE START DA 7'E
COMPLETE ALL APPIJCABLE BOXES - INCOMPLETE NOTICES WILL NOT BE ACCEPTED
4q13FcTOR AB kTFVFNT_PRniFCT
Amended? LJ Yes LJ No
Emergency? af Yes L..J No
On Hold? 1_1 Off Hold?
Work Shift:
7am-4pm
3 pm - 12 am
11 pm - 8 am
(other)
Work Shift and Project Dates must be exact
xv,rs.o.v.r.■
hi 1 W Th E Sun
X A' A' X
COALEACT0EIMORIMAT- (1.111
Company Name
Contractor Cent No.
-Si—gunny.
(Primed Name)
PROPERTY OWCFR INFORN14TIO?4
/4 ,4te /I'M A)/
iqg
Phone No
Name
I7',S4 40,4 tr,di 676%
Addrss
&;g/e,s Ave. Ei 617.0.4J.,60.
Phone No. 72 es Li
(2c) //
/Atodif-y
(J) 904753
Owner's R.
/1/, .
AcLiress
loo Site C.A.S. l ?bone No
e4C74 ".°C) (G71) g — /Ars'
Job Site FRO TFCT 1VFO,RM4TTON1
Actir=s I Type
City
ZEP + 4
County
/2e? 6246y
&k' •J
`7J,(
Age
WA
i sire
Facility
$41/e /51--,44,1V
OLIkNTITY OF ASBFCTOS
TO BE REMOVED, OR f 1 ENCAPSULATED
No. 45°6' sq. ft.
each box below
fireproofing
popcorn ceiling
=3
LJ
LJ
CAB
sheet vinyl gkiler
ati a
W
boiler insulation
j duct paper
1_J duct tape
No.
each box below
0 mag. pipe insulation
air all pipc insulation
ln. ft.
LJ
1Z1
Volows,7e LI' wet methods
0;11-VS,
1_1
cement asbestos pipe
5/a .1C
ge•frt-....c
/2&o
Indoor? IS Outdoor?
camoj....kaiaTimiAa22E
each box below
neg. p. enclosure
glove bag
mini enclosure
wrap & cut
al each box below
Li 1/2 mask, APR
LIT full face APR
PAPR
Li Type C continuous flow
Ld HEPA vacuum D-
1,zwy
eoweeire 41Z eStliaX
11CCIRAV PCAITCI2
Type C pressure demanctIECEIVED
CITY OF TUKWILA
NOV 1 2 1997
RECEIVED
CITY OF TUKWILA
NOV 1 21997
PERMIT CENTER
Agency Case No.
9700812
t1Qe tC f Se Vnly
PUGET SOUND AIR POLLUTION CONTROL AGENCY
110 Union Street. Suite S00, Seattle. WA 95101 -2033
Of—
E OF INTENT
Q PERFORM:
Date Received
1PGA 0C129 1997
Agency Use Oniv
A. Project Tv e: i 1. ❑ Asbestos Removal 1
Asbestos Removal & Demolition ! 3. L i Demolition. No Asbestos Removal
B. Property _,, ,!
Owner: f�l.,rlS I/ niftily I r(l 1 P1 ore: f4/f) 9.1 // S-
Froperty Owner's
Mailing Address: 1 %S •S !/ /`/'�'�•s Ale f Cirv: State: I c io: y z/
C. ,'Asbestos eu. 1SEP .V.'rC.f.1RLYTN.ISWWILDETOUR xgrtie.v MA /UNGLLREt Contractor
Contractor: PERFORMANCE ABATEMENT SERVICES, INC. Owner /CEO: Reid Williams
MailjneAddress; 3201 13th
Avenue
S.W.
WA
lZir,: 98134
Phone: (2061
Fax: (206)
467tiS733
623 -2091
Contractor
Job No.:
IZ /iO
City: Seatt �e
State:
D. Site
Address:
Project Manager or
Contact Person:
/%a — 7/o S, t$-ay JC
A42.
City: 7/4/A (StateJ"4 1 zip: /a / g
.1 Phone: (./ 673—//-S 7r.
E. Asbestos Survey or No. of Date Survey was G Was Asbestos Found? Pries
lvfat'1 Presumed: `St.^ucrdres: f Conducted: / J2 3/57 1 ❑ If No, Attach Survey
A,V AHEtt:L•RVEY JSREGt'JREDBEYCAE.1L.'.GE.VOLI 10N PKUJEL:S
Ah-ERA Building Expiration
Irnoeei Narrx: /4 ✓iQ i0s,fe-e /Yep/ : Certification No.: /VC Date: /zf TM7
•
F. Demolition 1 No. of Start
Information: I SL- ucrures: Date: % //i
Demolition eittar NAME rftAL E:Yrd.1.1MIUM.; AUUNEJS t, VOX f.40MA
Contractor: re Le 6Oered/�riadt�
191
1/' !NAM
'U Training Fire (List Fire Dept. as demolition contractor below)
r, Ordered Demolition (auach copy of Order)
t uunv LN::Jt mr4. e.er.time .
P:tone: (
C. Asbestos Project 1 No. of Structures:
Information: (sec back if > 11
Start Completion
Date: ///4/9 7 Date' JIf /s /97
Wk. Days
Hours: grim
M. '1' W Th Sa Su
- Sao it
I Will all asbestos material be .Yes
Total Quantity to be Removed: Linear Ft. / /f /31- ' Scuare Ft. f removed by tiroiect completion? • ❑ No
Taermal System Insulation: I c: Doilre \Furnace lr.s. ■"!■ Duct Ins. U ripe ins. Other. r. c ?411. �:.✓
Sirfaein" lvfat'l: ' MC Fi it o ing • Palms • Plaster Texture:! Coatings Other
Misc. Mail • Cement Ed. • Cement Pipe P Flooring Ma['l II Rooting Nat'l j Othe^. rktord.7G
/475.1V444' j'-
H. Asbestos(Demolition Project Categories:
1. ❑ Owner- Occupied R =idenrial Ashertrs Removal Project
❑ Owner•G upied Residential Asbestos Removal de Demolition Project
❑ Owner- Ckonoied Petridential Demolition Project, No Asbestos Removal
Notification Waiting
--i
proie:r Fee
Period
NON- REFIJI`NDABLg
S25
.
Prior Notice
2. 0 All Other Demolitions With No Psbesms Removal Project "'
10 Days
3150
3. ❑ 10 - 259 linear feet or 43 - 159 square feet (see back of form for options)
3 Days
5150
4. L1.260 - 999 linear feet or 160 - 4.999 square feet
10 Days
10 Days (�—
3300
S750
S.. 1,000.9,999 linear feet or 5,000 - 49,999 sauare feet
6. U 10,000 - 49,999 linear feet or 50,000 - 99,999'scuare feet
- 10 Days
S2,000
7. U 50.000 - 99.999 linear feet or 100.000•- 149.999 sauare fee: '
10 Days
S5,000
R. • 1CO.000+ linear feet or 150,000+ square feet
10 Days 510,000
9. ' Emerser.c Asbestos Pro cot or U Emersencv Demolition Project •
Prior Notice Twice, Pro'ect Fee
10. L. Alternate Means of Compliance for friable materials or • Demolitions
10 -Day Review Period Twice Proiect Fee
11. 0 Alternate Means of Compliance for nonfri able asbestos materials
Concurrent with Project 1 Twice Proiect Fee
1. 1 dot berry certify that the irtf uru.ttiur contained in this nonfrconwt. and supp1cmenrsJ data :Jescrtrd hxein, is w the be se o:' my knowledp
acc11' and comphac. 1 s1wJ1 rxn eLL or ailtry ary zocsni project or dcmuliut.i artivines to begin 'argil the appcptiate waiting period has
elapsed
Performance Abatement Services, Inc
Repre.emir,
/'/x9 /f7 Dare
Ca. 'np/er:ner Rn'ren'
Pe r/a:rred By.
rcrele
1
1
r u"
('a rcel 2
;shed "" r
/ qU / /
lfo $ /
,pr. •
I/
limn
' 1 ' 1 r I.
1 r :2:0 9e� Shod i.71io
IfRe(wif
Slag
I, ':i1h11l)
! fy.oIIo.=
r
+, ,J
,. Nrrh .-ry
• Clehti3
•
HOtt3T112 Rov
r
Itt (W 11($ t \,
'. ' 1
ocessui9
Parcel 3 / ?lam i
flll
I do
n , Gnla7r 11i0 ApCn •• :� (i
1 / Hurler). I
,1.4
Ti
romitt 1 1• f
Shed I. i o:�
" V . . ,
.-----
ice' \� � . Flow
t' 0 11••!...... ^."�' .rte ,.i'' %/' L /••
! •rte J. Cr „••••••' /1 ` �J,�. �1
tJfalr : 'I hr, loottlirns at 'r% 1..- :'
oll icoltifet shown nrr approximole.
M x,33
' Q1w .. ,. • � ._ •
m' ,�z..._..
coo ,
•Oc x24 -S? 12:08, Wi vnv i 7 7e Femi 7y Furl Ct
EXECUTIVE SUMMARY
• - . J. _ _i 1 U.Z. ... .1
6£S -P694
v.+
Asbestos- containing material (ACM) was identified at the Tukwila Property as follows:
Tr ;nsitc
S; ing,les
(7120 & 7140 Gdy
Way "Darn House"
& Garage
-1,400 ft2.. • 15% C
7120 Grady
Way
-3,00
7140 Grady
Way "Farm
House"
Er iahle Ccr:dit,cn
No Poor
Sink i 7120 Grady Way: { 1 sink ; 0.8;1 C j i ' Fair
Undercoating ; Kitchen
Vinyl Flooring: 7120 Grady Way:
tan , Kiu:i:en
Vinyl Flooring
and Floor Tile
7101 Grady Way:
Throughout
Structure
`100 fc2 Overall= 'Yes Fair
12S(.1 •C
ft= Overall= No Fair/Poor
Apo 2 % -37 C
Ducting Joint
Tape
7140 Grady Way
"Fare: House ":
Basement NVAC
Ducts
Boiler
Insulation
7140 Grady Way
"Farm House ":
Basement
100 lin. ft. 50 C i Yes. I Poor
20 ft'
'
1O% C
Poor
No Fair
Vinyl Flooring
7140 Grady Way
"Farm 14cusc" :
Fi. Bedroom
Vinyl Floo :±r
7160 Grady Way:
2''4 H. and Kitchen
9" Brown Floor
Tile:
7I60 Grady Way:
Garage/Office
20 ft;
150 it2
50 ft?
Overall
?04C
i >1.0% C
to Overall =
...._Fc C
1 U..eraii=
9 C'
TuLwila Pruprriy
Tamil, FJn C'snler
P.0.3
r e:., ia: Summary
F38c 2 RECEIVED
CITY OF TUKWItA
NOV 1 21997
..ww «,.Jw.r.�. ...+•yyM JyM.pFw.u.•u.,Mr...,n..n«..
.Oct -2.4-979 12:09P W i 1( rev 1 1 70 Fam? 7y Ftt:;
Riverview Dairy:
Cooler, All •
Ceilings, Flashing
esiNantity
'5,000 ft2
••pit.•:• •'�J.•.�1..':��.M•.••
0- .085 -965 r'• '' �p �0
•. •:5: '�. r'.•:�.
Boiler Packicg
wiaterial
Rif Core' • - Riverview Da4r,
Flat Roof •
C= Chr sotile, A =.Arnoaite• Cr = C:ocidolite
•
To *40ml/el)
• , Tuk•a•ita Pri ri}
, Mist' Family Fun C,nrur
, , v..u.•.•;1. .1.. • •.. ••1 . • • •
E t. :':::vc Summary
r,
P•=: =' RECEIVED
CITY OF TUKWILA
• :NOV 1 21997
LEE'S SANITATION SERVICE, INC.
P.O. BOX 66537 — SEATTLE, WA. 98166
PHONE • 242.6911 / 228.4282 / 839.3637 / FAX • 242 -1452
LICENSE NO. LEESSS347CM
"COMPLETE SEPTIC TANK SERVICE - SIDE SEWERS • BULLDOZ) o"
TO .Z461.11.1) l);)/ •(=1:
BILL
//5s-'1
sT.e 99 -V
CITY OFETUKWILA
NOV 121997
PERMIT CENTER •
INVOICE 58005
DATE
P.O.
N
/?/?
ON
REMARKS:
•
f.ytic,
AO 6 -he
....
Al, .
a' :1 ..C• -
A�,
LP GL�
��: IL I L1/1 rill
11
/ //a_,z_ ih : 7 /o0 CiA)y
751) Oa1,
II
7l ao
'71L(D
11
11
7150
1
ii
71G. 0
11
1%
REMARKS:
n• .w. a trot tna ass WAS 11114 W 5& u¢ !Ills ass - tie m
Lloyd Enterprises, Inc.
P.O. Box 3889, Federal Way, WA 98063 -3889
FAX: 838-0103
PHONE: 874 -6692 / 927 -0416
TICKET M'
DATE TIME PLANT HAULER TRK DRIVER
l
!i :1f : 1'1,'1'' (:i,•1 ' :'Ft ono 1 '' TT`!P
CUSTOMER
1..00 1.7 1..E i :' ; :IAI•17.'(f11 'r f11,1 CUST.ORDERI
F' •C) LI0X 665.r;'
:if' AT T'1. fi WA 981 (,(
• ,,. 691 I
•i
QTY • UNIT PRODUCT PRICE
CI . <<;i::. 1N P 1' 9(tNT? - WI It..;'.;1_ . tal'100.
AMOUNT
rif
POUNDS
Z t)
C OM
o tv c 2
3m
_v 1
Ir
GROSS:
TARE:
NET:
I.1..4 b'l11
356 00
55720
DRIVER SIGNATURE
Customer ;Weasels and sprees to hold harmless Uoyd Enterprises, Inc. br any damage to his bor real or personal property quad by delivery of matedalsIisted above. AU niat.rial
having neon dumped out in trucks Is oonsiderad sold and is not warranteed to new any particular specifications. When material Is no longer acceptable it is the solo c ' •'
Wye( b notify seller to stop delivery. The owner of the within described premises Is hereby advised that a lien may ha Hai .W4 1.• • •• • "
not paid within 30 days. Interest at 1 tr2 % par month will he
%NOV 11
.
•
1, •
o° O
• x tmol
ZCO
F.1 "C° plif
co al
$ Q
cn w it 04
N • ? N •
co
W et
m •
co
LLOYD ENTERPRISE:3 INC,
PIT RUN FILL • CRUSHED POCif • TOPSOIL
MaIIing address P.O. SO); 3889
FEDERAL WAY, WA 98063
2102 8. 341ST PL.
FEDERAL WAY, WA 98)03
PHONE: 874.6682 e 927.0416
11
Address
QUANTITY
DESCRIPTION
PRICE AMOUNT
.•41111111111110 or 7
CRUSHED ROCK
RLSCE"I TVrD
CITY OF UKWILA
NOV 1 21997
PERMIT CENTER
SPECIALTY CONTRACTOR
849 S. 164TH ST. P.O. BOX 66537 SEATTLE, WASHINGTON 98166
(206) 242.6911 242 -1452
RECEIVED
CITY OF TUKWILA
Nov 1 2 1997
Date October 29, 1997
Huish Family Fun Center's
1155 Graves Ave.
El Cajon,. Calif. 92021
Phone: 619 -593 -1155
Fax: 619 -593 -6897
City of Tukwila
Tukwila, Washington
Subject: Property Demo Permit
Family Fun Center property,
7100 -7170 South Grady Way
Tukwila, Washington 98188 .
".Exhibit B•"
J & G Nursery
710Q
7120
7150
Garage
,7140
Shed
Garage
7160
Garage
7170
Shed.
Approx.
.1
200
1000
1000
1000
400
2000
400
3200
2000
400
4000
200
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
Total square footage to demo: Approx. 15,800 sq.ft.
Demo Contractor:
Pauletto Trucking and Excavation
Washington State License: PAULETTO 082LA
r riri :.,...i cn iii ■� .:.�,._r:rL r . '.
ricmas P. Keefe, Are ChteJ
Mr John Ht:ieh
c/o Family Fun Center-.
i455 Graves Avenue
E1. Cajon, California • 92021.
Dear Mr. Hush:
We have determined that per Uniform Fire Code 103.4.5, the
buildings located • at 7100 South Grady • F7ay corsitute a hazard to
'public safety and need .to be demolished.
Please have these buildings demolished within 14 days. A
rei:-ispeczior..will be • conducted at that time. If. you have any
questions regarding this issue, please call the :ire Prevention
Bureau at 575 -4407.
Enclosed you will find a copy of Uniform Fire Code 103.4.5.
Sinyerely,
•
Chief Thomas Keef
cc; Steve Lancaster
Planning Department'
Headquarters Station: 44..; Andover Park East • TuioVila, W'astilnnton 08183 • Pho. (206) 5754404 • Fax' (206)
EIVED
TUKWILA
NOV 1 21997
PLAN REVIEW / ROUTING SLIP
M DAB 11131q7
ACTIVITY NUMBER
PROJECT NAME
OW
/1140. Gem Wy S
DAP
G DIVISION ❑ FIRE PREV1ENTION PLANNING DIVISSIO�N'/ //� gi
PUBLIC WORKS `� S1'vRU�O ❑ PERMIT COORDINATOR S
DETERMINATION OF COMPLETENESS: (T,Th)
• COMPLETE tgf NOT COMPLETE ❑
COMMENTS
DUE DATE I t
NOT APPLICABLE ❑
97
TOES /THITRS ROUTING: PLEASE ROUTE fl NO FURTHER REVIEW REQUIRED ❑
ROUTED BY STAFF ❑ (If routed by staff. make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS: (tea days)
oUEoa,E Sao X97
APPROVED ! ! APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL
DATE
CORRECTION DETERMINATION:
DUE DATE
APPROVED I J APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) Q
REVIEWERS INITIAL DATE
(Cerdflcadoa of occupancy requited. )
ti±, • "4, • Irv.. • ••■• lorm. werno—ra
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER 01111 DATE A.19:7
PROJECT NAME _an i Fon Center au° libenV
11 0 Gragy Wy 5
DEPARTMENT:
BUILDING DIVISION • FIRE PREVENTION PLANNING DIVISION 0
PUBLIC WORKS STRUCTURAL. PERMIT COORDINATOR 0
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE
COMMENTS •
1
DUEDATE II 10) i cra7
NOT COMPLETE Ei NOT APPLICABLE El
TUES/THURS ROUTING: PLEASE ROUTE •E NO FURTHER REVIEW REQUIRED V
ROUTED BY STAFF n (If routed by staff, make copy to master file & enter Sierra.)
• ‘;!..411
REVIEWERS INITIAL
DATE
APPROVALS OR CORREC ONS: (ten days) DUE DATE clis7
APPROVED fl APPRO D W/ CONDITIONS 1■4 NOT PROVED (attach comments) El
REVIEWERS INITIAL
DATE
/11111111••■••
CORRECTION DETERMINATION:
APPROVED n APPROVED W/ CONDITIONS
REVIEWERS INrnm.
DATE
DUE DATE
NOT APPROVED (attach comments) El
trArr:Aego:nn nf nectinancV reauircd•
1
..Lt• t+4:1 •
ais:M ..a,;r . x.:+• ua. fm.u. *rar�err.: +ararxe >:xf.fve:
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER
PROJECT NAME
DEPARTMENT:
BUILDING DIVISION El
PUBLIC WORKS ❑
M'i9"7.Ot98
1140 o I Gracgy wy S
FIRE PREVENTION PLANNING DIVISION ❑
STRUCTURAL ❑ PERMIT COORDINATOR ❑
DATE 11134447
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE 1 1 ((0
COMPLETE n NOT COMPLETE ❑ NOT APPLICABLE ❑
COMMENTS
97
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
DATE
APPROVALS OR CORRECTIONS: (ten days)
1
DUEDATE la 01R1
APPROVED ❑ APPROVED W/ CONDMONS ❑. NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL 7'J I (9
DATE j1'(e'X1)
t
CORRECTION DETERMINATION:
DUE DATE
APPROVED ❑ APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL DATE
frwrriReitine of ncet nancV remised.
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER � I q DATE i'iAL��L/ l 3/97
PROJECT NAME � �
DEPARTMENT: 7140 ('�IO
� CrY IAJy S
BUILDING DIVISION ❑ FIRE PREVENTION ❑
PLANNING DIVISION
1
PUBLIC WORKS STRUCTURAL ❑ PERMIT COORDINATOR ❑
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE ❑ NOT COMPLETE ❑
COMMENTS
DUE DATE I I (D 1 c "7
NOT APPLICABLE ❑
TUES /THURS ROUTING: PLEASE ROUTE fl NO FURTHER REVIEW REQUIRED ❑
ROUTED BY STAFF ❑ (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS: (tea days)
APPROVED ( l APPROVED W/ CONDITIONS [7:1
DUE DATE
NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL jif DATE 11 ` g y -q-7
CORRECTION DETERMINATION: DUE DATE
APPROVED ❑ APPROVED W/ CONDITIONS ❑
NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL DATE
..i.....••.........v ..enured_
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER
PROJECT NAME
DEPARTMENT:
BUILDING DIVISION
PUBLIC WORKS
MZ.q'I.0.98
1110,
Graay wy s
DATE 1113/97
FIRE PREVENTION PLANNING DIVISION a
STRUCTURAL Ej PERMIT COORDINATOR Q
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE
COMPLETE E NOT COMPLETE El NOT APPLICABLE 0
COMMENTS
TUES /THURS ROUTING: PLEASE ROUTE
NO FURTHER REVIEW REQUIRED El
ROUTED BY STAFF L 1 (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
t
APPROVALS OR CORRECTIONS: (ten days)
APPROVED El APPROVED W/ CONDITIONS
DUE DATE 1% aoIR"
NOT APPROVED (attach comments) 0
REVIEWERS INITIAL /Z —CO DATE I) /PI/
CORRECTION DETERMINATION: DUE DATE
APPROVED t ) APPROVED W/ CONDITIONS n NOT APPROVED (attach comments) Q
REVIEWERS INITIAL DATE
• • r "3 W:••$irmS►rrlYrrri.) 0..1 •A.•4
uc tn:.■ tv Uwrt.., tent t.
DEPARTMENT OF LABOR AND INDUSTRIES
J..EE:' S %' SA•Nt t Tt�; M::
$EA:TTL .4A : '981.66 :r; .
•
STATE OF WASHINGTON
F625-052.003(3-02)
L. DETACH TO DISPLAY CERTIFICATES • t WWII.,
a `• . :.P }S :/, n�N . r� t +�y,f , o h [ °/ �. } ' lC 1 gyp/" '�i .,S'r`A1'.. r u�S �.. ••1, sir..• . v h..'rr• ^ • • ?. j ' ry ;
rr)'.- S, 1i�.1�" %•"". ;•tlj'.•�• r'x, fr `�;4. ..�u��, •�,• .::-...,. � �
R u-YPY VU'�.r'r.r� �rW'4' �•'�• 'r•WJ•rV4►•sngd•r•u'••f�. •,••v •r'�V�•��Yti +••.�..� ".r��j!,�:
* f f'1.4• A'A•A'•�'�A•A 1�f'f' f•• 'MA A•A-A'•?'T'T A•A A•A�f f f f'•F f'ff ♦-f•A�•IAA 'A "• f'A A'f -A'f A f'f •f��'f A •A f f f A A * f � A • • f 1 f f f f' �'�• f' `I(=Ti.
Seattle -King County Department of Public Health
SLUDGE HAULER REGISTRATION AND VEHICLE INSPECTION CERTIFICATE
CERT. NO. SH076
GRANTED TO LEE WARNER DBA LEES SANITATION SERVICE INC
LOCATION 849 S 164TH ST, SEATTLE
MAILING ADDRESS
LEES SANITATION SERVICE INC
PO BOX 66537
SEATTLE WA 98166
FOR A PERIOD BEGINNING JANUARY 1, 1997 AND ENDING DECEMBER 31, 1997
J8ECTOR OF PUBLIC HEALTH
DATED JANUARY 1 , 1997 BY
SUBJECT TO ALL STATE LAWS, COUNTY BOARD OF HEALTH RULES ANO REGULATIONS, AND /OR CITY OR COUNTY ORDINANCES
PERTAINING THERETO, THIS PERMIT MAY BE SUSPENDED OR REVOKED UPON VIOLATION BY THE HOLDER OF ANY OF THE TERMS
OF THESE REGULATIONS. THIS PERMIT IS NOT TRANSFERABLE AND MUST BE POSTED IN A CONSPICUOUS PLACE. THIS PERMIT IS
NOT VALID UNLESS SIGNED BY OPERATOR.
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OPERATOR SIGNATURE
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RECEIVED
CITY OF TUKWILA
NOV 1 21997
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'<. PLEASE DETACH AND SIGN
CERTIFICATE BEFORE PLACING
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SIGNATURE
ISSUED BY DEPA
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