HomeMy WebLinkAboutPermit MI97-0199 - FAMILY FUN CENTER - RESIDENCE DEMOLITIONCity of Tukwila (_
(206) 431 -3670
Community Development / Public Works • 6300 Southcenter Boulevard, Sutte 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:
242304 -9013
7150 GRADY WY S
DEMO
MISCPERM
DEMO
001
North:
TUKWILA
Permit No:
Status:
Issued:
Expires:
Occupancy:
UBC:
Fire Protection:
.0 South: .0 East: .0 West:
Sewer: TUKWILA
Slopes: Y Streams:
Contractor License No PAULETE0082LA
MI97 -0199
ISSUED
11/18/1997
05/17/1998
DWELLING
1994
NA/
.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 ********* ** *** lc ********* **** lc* ********* lt****** ** ** ** * *** * * ** ** *** ***** ******* lr*****
Permit Description:
DEMOLITION OF 1,000 SF SINGLE FAMILY RESIDENCE
AND 400 SF GARAGE INCLUDING SEPTIC SYSTEM
ABANDONMENT.
kk********* * * * * * * * * * * * * * * * * * * * * * * * * *** **** k * * * ** * **** k *** * * * * ** k *pit*** ** * * * * * * ** *** 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: Sizelin): .00
Flood Control Zone: N
Hauling: N Start Time: End Time:
Land Altering: N Cut: Fill:
Landscape Irrigation: N
Moving Oversized Load: N Start Tine: 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:
kk********************************************* k***** * * * * *k * * * * * * * * * * * * * * * * * * ** * * * **
TOTAL DEVELOPMENT PERMIT FEES: $ 46.50
k**************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Center Authorized Signature: Date:
I hereby certify that I have read and examined this permit and know the sane
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.
Address:
Suite:
Tenant: ;tutus: ISSUED
Type r MISCPERM Applied: 11/03/1997
Parcel #: .242304- .901 3 rssued 11/18/1997
*•k k''k k'* k°k* * ** ** **•k.:k•k- *•k * *;k k ** * ****•k * *•N.•k* k'k k*•k** k *•k•k'k* ** * **** k ** ** *•k k *** k *•k** k
Perniil:. Conditions:
1. EXISTING TREES CANNOT: BE REMOVED WITH THIS PERMIT.
2. Temporary erosion control measures :sha1.1 be implemented as
the first .order of bu1i ness `to; pt- event :$edimentation off-
site er;.into exist ing s'torrn drainage t "aci.l i tieR.
3 '
The site .shall have;:permerren t eras i:on control. measures in
place as soon as po o,ib.le a #ter fina1 /grayling has. been
completed, and prio,r-,to the Final 'Inspection •`
4. ALL CONSTRUCTION ACTIVITY ASSOCIATED WITH-THIS DEMOLITION
SHALL BE LIMITED. TO. WITHIN 10' OF THE:BUILDING EXTERIOR::
5. Any Septic' °'tali k . '' in the area hat i be pumped, empty; and
removed _or filled with sand. A .'copy of documentation from
bu'.;iness that performed: the pumping shall be provided,
to the; =Cit- y',Utilit ies, .Inspector-LEE'S SANITATIONINC•;
SEPTIC PUMPING RECEIPTS, ARE ATTACHED AS PART OF THIS .PERMIT,,
6. No che,nges``wi1 1,, be made to the plans-,unless approved by :the
Tukwila Blinding ing Divi ion. •
7. Comp,l,y with the requirements;o-f TMC 46.04, Demolition /Reloc-
atio'r'r{ of Structures and ArtjP16.,87 of the Uniform Fire Code.
8. Re Moire all .weed::, concr-;ete c;.stone; foun'.dations , flat :con
cret,e, concrete ' pa.ti os,` masonry walls;. garage floor.., drive-
and s;imi l,ar s•truct ures'And all ;loose miscellaneous
mater';i a 1 Properly cap. san i tary sewer and water connec• -,•:.•
tions '. properly fill`'or' otherwi'se . protect all basements,
cellars. ,,aep`tic, tanks, wells and other ,excavations.
9. Va I i d;ity ofrPeritri t. The issuance of a permit or approval of
plans, �spe.cif:ica tions, and computations' shall
, not be 'con -
strued 'to be a permit for, or an .,approval ;of,; any violati n
of any- ;of. the provisions of the,' bu i i d i ng, code or of any
other ordinance.. of the jurisdiction. ' No "permit presuming to
give authority to violate: or cancel the pr:ov i i oris ;of
code shall'-be valid.
CITY OF TI KW►LA
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: _
/ -h, /.,X (A/r/, 6 � �ilr % ( r• re. /2 •S .6• ) c -•
Value of Construction:
`j 33.3
3t
'—
Site Address: l / '' City State /Zip:
7 /Sd •'o Gia..4.4,7 6 My /Lt /',l' / / ? /t1,.:5 h r,17 . +'S'
Tax Parcel Number: .
./'- 9f71 3
qm.3.744
Property Owner: .,
/ iii,, /, � .ni, / /,w l;,,,,,ty.; _i_.--;...k....
Phone: •
4I /F-S'., -/ /:
Fax #: _
61 ' - .� % - 6 S'` 7
Address:
Street Address: _ / �f City State /Zip:
/ / S <. (_ 7.Z4'L'CJ!; .ri . (2. (:- (lit A.) R. 9'?'
Contact Person: JJ ,cZ ,/�P4'P !
Phone
Street Address: f_ _ f/� / / City State /Zip:
1.
Fax #%:
` / -/
0 Metro
Contractor: , 'LL //
1`l/!.l� /'' % .L'l/C,t'//i'e' . 6,CCcti.1.7 /1 Op
Phone:
'C"1;: -Mo --4/V20.
Street Address: es�yy /(J �L//� tt ''11 � City State/Zip:
(.%C." / / S/? lf�•�A/C /J i/2 * ?e.,1 /(rn(" ()a4 4. �ec'.S-
Fax #:
Architect: A,
/ 1/44h.1// Mgt/ ,7i/% rxtv._. // tr &4/'/l'l// S, .. i ee,
Phone:
y/ /. - Y2' -G'(7 V 0
Street Address: City State /Zip:
/ /JiU lfiVir,i, 4)4c/ I E .36.:) /fi/ 'UF /1/r l`o'ns" •
Fax #:
X
/1 ; S`' 2 ('//
Engineer:
/(:)4/2- / .-C f 5 '''Al (tviA /.146,7/6: //, f'
Phone:
,Y'6 -, 75% -6.7..;1z
Street Address: City State /Zip:
• / 2/t 2i ti4oe Uo. / /Frvr 4 . ) ',%?32-
Fax #:
c Si -J'7SZ•
MISCELLANEOUS PERMIT REVIEW AND APPROVAL REQUESTED: (TO BE FILLED OUT BY APPLICANT)
Description of work to be done: /�,�,/� h�� p /'%�� Leo .'>ir.L(c IIt k O2 /NL1fSC' •5/1 cpr �-'L'
Will there be storage of flammable /combustible hazardous material in the building? ❑ yes f si no
Attach list of materials and store a location on se arate 8 1/2 X__ 11 paper indicating quantities & Material Safety Data Sheets
Above Ground Tanks
Demolition
Parking Lots
❑ Tem orary Facilities
Antennas /Satellite Dishes Bulkhead /Docks Commercial Reroof
❑ Fence ❑ Mechanical ❑ Manufactured Housing - Replacement only
❑ Retaining Walls ❑ Temporary Pedestrian Protection /Exit Systems
❑ 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
U Curb cut/Access /Sidewalk U Fire Loop /Hydrant (main to vault) #: Size(s):
❑ Land Altering: 0 Cut cubic yards 0 Fill cubic yards 0 sq. ft.grading /clearing
Sanitary SIdo Sewer #' .(PT /L 1416441 Sewer Main Extension 0 Private 0 Public
Street Use ❑ Water Main Extension 0 Private 0 Public
Size(s): 0 Deduct 0 Water Only
Size(s):
Size(s): Est. quantity: gal Schedule:
❑ Moving Oversized Load/Hauling
MONTHLY SERVICE BILLINGS TO:
Name:
Phone:
Address:
City /Stale /Zip:
0 Water
0 Sewer
0 Metro
0 Standby
WATER METER DEPOSIT /REFUND BILLING:
Name:
Address:
/v//1-
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.
Data application rcoI:
Date application ex ros:
Arlon a by: (Initials)
1
ALL MISCELLANEOUS P "MIT APPLICATIONS MUST BE SU :. TTED WITH THE FOLLOWING:
D ALL DRAWINGS SHALL. BE AT A LEGIBLE SCALE AND NEATLY DRAWN
D 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 be the builder OR submit Form H -4, "Affidavit
in Lieu of Contractor Registration ".
Bullding OWner /Author!zed Agent .1f the applicant is other than the owner, registered architect/engineer, or contractor licensed
by the State of Washington, a nota,ized 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 l AM AUTHORIZED TO APPLY FOR THIS
PERMIT.
BUILDING OWNER OR AUTHORIZED AGENT:
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
one
Bulkhead /Dock
Submit checklist ; No: M -10
❑
Commercial Reroof
Submit checklist No: M -6
Et
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
O
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 Walls - 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 ".
Bullding OWner /Author!zed Agent .1f the applicant is other than the owner, registered architect/engineer, or contractor licensed
by the State of Washington, a nota,ized 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 l AM AUTHORIZED TO APPLY FOR THIS
PERMIT.
BUILDING OWNER OR AUTHORIZED AGENT:
4
Art
ric�ish
4
a
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L- �`
one
Date: /0 — :'c,-
��� % ?"I /
_r,'.
��'
��'97
Print namelt, N / //,
Address:' -
City /Slate /dip:
: ,
MISCPMT.DOC 7/11/96
k/k kkk****k,\1k�kA* kkksJlkAhA*kkkkk kAflkkFA #AHkAA 1kAkk *A *Ak•kAkkkk
.0CI1 Y OF TU(WILA WA �k . ` TR- INMI1
kt4kkklk kk4kA kkkk, .kkd.. A kt kkl ik**k** kkkkkkk*k**• **
:
l'R N8t11.T 'Nt.unber,. 097'00673. Amount: 4.,.50 1 i.,03 /;a7 16 »38 .
Payment• Method« GNLCI; Notation: HUISI1 FAMILY FUN '.Init..I(JP
Permit No» MI97 -- 0199 Type: MISGPI;RM MISCELLANEOUS PERMIT
Parcel No 242304 -9063
Site 'Address t . 15034 GRAPY WY S
Total Fe,e z
Thi,. Payment A6.7,0 Total ALL PrntC » 46.50.
Ilalarice: .Q0
)t*•k * *4r.1tk•41l••k4 .** *akk'A *k #k *. Vk*• k*.1k:1*d.1*k a* 11 *4h*kdtk.kk *•Atk***±1.•k.*4 ***
Account Code .neegr i pt i on AmoOlt
«00 /J22 100 I3U1:1.0I:NG• - NOMRE.S 42.00.
000/386.904 STATE BUILDING SUltcHAR6 4�5t >:
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 981
INSPECTION RECCE "D
Retain a copy with d._.. ,nit
(206). -4,3 1 -3670
P : 3c • ' "
At . A/ A Ili . / / / IL'
Type • ms• =c•
/ / -.•�
Adtersi 6 6,4 4
Spec(al instructions:
Date want
�r �$
Jn ,. (
I�(�/
a.m.
P.m.
Requester:
Phone No.:
pproved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Inspector.
Date:
ri S42.00 REINSPECTIO � EE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection.
..wor msna rVxe7ttetRR'M10;'
INSPECTION RECi
Retain a copy with'
�iii,�,,�
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Yri+7 -of`f
ct
irnt
1 n
Con
Type of p tlo
AS7 716?
/ L� s
--
Date c�l�d: as_ n l 1.
Special instructions:
Date is ited1( q —7 41111p
Re � 1:Z7q i ot 10
Phone : 9'914— 1•71
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Inspector:
Date:
111110157
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
}
INSPECTION REC,RD
Retain a copy with emit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 9818
PERMIT NO.
(206) 431 -3670
Project r
(�
Vol
Type of in%s�ction: �
ins/---..e.
64;4--
Address:
called:
Special instructions:
_
Date wanted : /
/
"f
Requester:
Phone No.:
Approved per applicable codes. I f Corrections required prior to approval. •
COMMENTS:
S42.00 REINSPECT '• N FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
2
PROP��
coMMokc\i'
GREEN R1vER
Boon'al
1 t' r;�.. na that tho Plan Chock ,ert ■
subicct to c, ror3 and omissslo Ai_4 '
plc= dam not fie
cc ptod ;
00c0 itf*,;10110yor
41.1firft, AY .J
Concrete
7
1
Gross ery
Bushes
ato
tractor's
� / 1'
Leo // / ' '•1
hl GT -11 -$-
n�dslM /" p� /� 1
Si / 1 �..-t
--- / cD �-- Approximcte
/ Q° / • of Soil Stockp
C7 l��. -_J
/
e-s-0.,GCY1-17
AT-6
i
. • • • • • • , .• • • •- • •• • .•-•■ • •, .•• '' : ,, •• • • :••■•••,......r. •-..,-.••••••:.: • •-•,t ,11.••••••,, •
NTON
NCTIO
25
71r,
0 2000 4000 RECEIVED
CITY OF TUKWILA
SCALE IN FEET NOV 03 1997
PERMIT CENTER
Reproduced with permission granted by THOMAS BROS. MAPS. This map is copyrighted by THOMAS BROS. MAPS.
It is unlawful to copy or reproduce all or any port thereof, whether for personal use or resole, without permission.
Geo ',.*Engineers
VICINITY MAP
Demolition sites in relationship to existing
significant trees. DP, 11 -14 -97
'c
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;6X
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 E TIC TANK SERVICE • SIDE SEWERS • BULLDOZ qIG"
BILL
I TO
W'7 • l(.• L•C••r L• /t L+.•i..,
CITYROFETUKWILA
Nov 1 2 1997
PERMIT CENTER
INVOICE 5 8 0 0 5 REMARKS:
DATE
P.O.
N
/2/2/9 7
„sit X12.
PHON
•-..593 •i
6-
Aer /1•111114W /F A
A
F7//76 ,a..1 ,Air l.
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-7,50 dal,
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woke low mow wan .r.. r .... nr vns q a a w1 wa Mta.a.Y .•_ L.1 flS .et bait ties ifs.
Lloyd Enterprises, Inc.
P.O. Box 3889, Federal Way, WA 98063 -3889
FAX: 838 -0103
PHONE: 874 - 66921927 -0416
TICKET #
DATE TIME PLANT HAULER
CUSTOMER
CPA A
TRK DRIVER
t•►nt7t ,. .r.r p
JOB INFORMATION
1..00 17 I.•E'1': 4: 1.1A1.111 f :li :I' OH •
CUST, ORDER #
p f) I:40X (,6:5 :y•;,
SEAT'11.fi WA 90 6(
206 -242-6911
•
OTY UNIT PRODUCT PRICE
AMOUNT
t•1 f'•':1' i' Silt.-1 1: 1,,11 11..1;1.
.t•61I
POUNDS IONS
GROSS:
TARE:
NET
DRIVER SIGNATURE
Customer Weasels and anuses to hold harmless Uoyd Enterprises Inc. bar any damage to hisj sr real or personal property caused by delivery of materlalslIsted above. AM niatirial
having been dumped out w trucks is considered sod and Is not warranlaed to meet any partatar specifications. When material Is no longer aoceptabN it is the sot. .�•���•'� °'�
buyer to notify seller to stop delivery. The owner of the within described premises Is hereby advised that a Gen 1714V PI*
not paid within 30 days. Interest at 1 to % per month will M �F +.• A .. ••
1
,tVOV 11 '17 09s17AM LLOYDENTERPgx9n WY Fcdoral WY, d/4
9
133.2 144
LLOYD ENTERPRISES INC.
PIT RUN FILL . CRUSHED ROW . TOPSOIL
Malling address P.O. E30): 3889
FEDERAL WAY, WA 96063
2102 S. 3415T PL,
FEDERAL WAY, WA 98 )03
PHONE; 874.6692 • 921.0416
To ld (.EEt.ti14 r Y' T 1 O t1
Address
City
Deliver
To
Date
147195
S8s.9a.
QUANTITY
DESCRIPTION
PRICE
AMOUNT
o alp
PIT RUN
s'.---
ptr 6+aNb
CRUSHED ROCK
'R., 1/1
£010-988 :MG
Pr
Q
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Co rri
co
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a pi
a rrDD
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RECEIVED
CITY OF TUKWILA
Nov 1 21997
PERMIT CENTER
`LEE'S SANITATION SERVICE, INC.
SPECIALTY CONTRACTOR
849 S. 164TH ST. P.O. BOX 66537 SEATTLE, WASHINGTON 98166
(206) 242 -6911 242.1452
7/ Au
RECEIVED
CITY OF TUKWILA
Lima 1 ') 1007
TO:
FROM:
DATE:
SUBJECT:
Department of Public Works
NOTIFICATION OF UTILITY PERMIT ACTION
Permit Center
Public Works Engineering
November 13, 1997
Huish Family Fun Center
7150 Grady Way South
Project No.: PRE96 -0037
Permit No.: MI97 -0199
Contact Person: Chandler Stever
Phone: (425) 822 -0444
John W. Rants, Mayor
Ross A. Earnst, P. R, 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)
i
PERFOVCEE 3201 13th Avenue, S.W., Seattle, Washington 98134
ABATEMENT NT SER SERVICES g
Telephone: 206- 467 -8733 Fax: 206- 623 -2091
November 11, 1997
Huish Family Fun Center
1155 Graves Ave
El Cajon, CA 92021
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.
A47
Paul Hanway
Project Manager
RECEIVED
CITY OF TUKWILA
NOV 1 2 1997
PERMIT CENTER
Dcparoncnt of Labor & Indust-1es
300 W Harrison St
Seattle WA 98119-4081
Phone: (206) 281-5473
FAX: To Regional Offices
71/0
NOTICE OF INTENT TO REMOVE OR
ENCAPSULATE ASBESTOS
THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 DAYS PRIOR TO THE START DATE
COMPLETE ALL APPLICABLE BOXES INCOMPLETE NOTICES WILL NOT BE ACCEPTED
•••••■■••■■■•..m....1.1.m.
AcHFcTng 4/3 ATFMFNT Pim iEcT
Yes Li No
Yes Li No
Amended? L--1
Emergency?
On Hold?
[//
Completion:
bun age:
/7E17
Li Off Hold?
fCaaalLIMEEMIATIO.
Company Name
Contraaor ten. No.
Wnrk Shift
7am-4pm
3 pm - 12 am
11 pm - 8 am
(other)
T Th
Wort; Shift and Project Dates must be exact
PROPERTY OW\TR INFORMATION
1-6/1"sf4w4ee i1efl'A4
AS
Irrnsnira *---- /7 — ---7—
(Pinned Name)
Phone No
"dri/ ,,%0u/4/
Name
Ae,4 triAl 67Ot
Add=
Ai/e..S Ad. Fi 6:•.0 N, AL
72 d
Phone Ni,.
(24c)
) 90-1753
Joo Site C.A.S.
/51,4( e.lf,4 /2C '-c
Job Site
Addrms
1,20 b4Jy .W
Csry
21P
C..ot.mry
Owner's R.
. 7S
Acidness
iPhone No
(‘-/f 3-93 —
PROJECT zyjmuLTELN Facility
I Type
pluarEIDEAsBEs=
TO BE If REMOVED, OR
No. 45.° ° sq. ft.
each box be low
Li fireproofing
1_1 popcorn ceiling
0 CAB
Age
WA I
si=
1 ENCAPSULATED
No.
11 each box below
mag. pipe insulation
air cell pipe insulation
cement asbestos pipe
Li
1n. ft.
sheet vinyl Z04 )/eia 5/4/-K-
. 60 4) oo !4-3
boikrinswation V1.44,5,741 .
LI duct paper
„.5,74-1e r4s,Wei4ic..e
5O aeifvS
Zoo
Indoor? 2 Outdoor?
CONTROL 45LIRFS 4V[) PIPE
Fait each box below
neg. p. enclosure
:CD glove bag
LI mini enclosure
0 wrap & cut
LI wet methods
Ld HEPA vacuwn
etrbuo.
Li
each box below
1/2 mask APR
L1 . full face APR
LJ PAPR
L.J Type C continuous flow
J Type C pressure demancIRECEIVED
CITY OF TUKWILA
14.0V 1 2 1997
RECEIVED
crri OF TUKWILA
NOV 1 21997
PERMIT CENTER
Agency Case loo._
9700812
Agency Vie linty
PUGET SOUND AIR POLLUTION CONTROL AGENCY
110 Union Stret. Suira SO0, Seattle. WA 93101-2033
I$vE OF INTENT
.._ O PERFORM:
Date Received
PCa 0012 91997
Agency Use only I
A. Protect Tyne: -1 1. L1 Asbestos Removal 1 2.,Asbestos Removal & Demolition 1 3. UI Demolition. No Asbestos Removes 1
B. Property
Owner:
Property Owner's
&tailing Address:
C. Asbestos
Contractor:
r .,
S /farLize Phone: (4) 9.?-.
itte / cicv: EL a/'cw
r: sISEP .V.v(CEM.r MIS WILL BEraRR r MAUNGL3EL Contractor
PERFORMANCE ABATEMENT SERVICES, INC. I Owner /CEO: Reid Wi1].iams
S talc : V e I Zio: ?1-47-2/
MailingP.ddress: 3201 13th Avenue S. 'I.
City: Seattle 1 State: WA 1 Zio: 95134
Contractor
Phone: (206) 46746733 JobNo.:
Fax: (206) 623 -209I
92/0
D. Site
Address:
Project Mana,g r or
Contact Person:
/Gd — ! //c s. 2-d y J City: 7'/'-4/A 1 State:04 1 Zip: V/ �C
1 Phote: (h 373 -N-s- _
E. g Asbestos Survey or No. of Date Survey was
Mat'l Presumed: f St:uceires: . /1 . ( Conducted:
A . F t - E R A Building ,ti.v L 8 !Jr.3£G1R£a o:r rav AsuI£c s
In eei t it Nan::
z2.40,4 /200, /re/ /eQ •
F. Demolition
Information:
Demolition
Contractor:
N. of Start
Structures: Date:
Y::l:r'.vAMf: Attlk £.vrid ,11AI(1.'.* .rrwIIESS 1.1 .IUX riN en
To Be A/errdor id
3,/-/ ( Was Asbestos Found? ees
1 0 If No, Attach Survey
Expiration
Certification No.: /VC P ('Date /2.../ %l
0 Training Fire (List Fire Dept, as demolition contractor below)
►' Ordered Demolition (auach copy of Order)
IIUK.v:,vIIn ?ME W.er: NEA£ ,
i
Phone: ( • )
C. Asbestos Project I No. of Structures:
Information: ! (see back if
Total Quantity io be Removed:
Tocrmal System Insulation: 1
Sdriaeing ❑ F -trotting ❑ Pints
Mist. ;v(at'1:1 Cement Bs:. Cement Pipe
Bnilairunace. Ifs.
Start
Date: 1/
Linear Ft.
Duct fns.
Completion Wk Days(t T \V Ttt Sa Su
f�- Dncc• / 1/157'97 Hours: 74#v - 330 n
'Will all asbestos material be
e/. Scuare Ft. ` rcrtloved by pro+ect completion? • 0 No
U Pipe. fns. ( Other. ).i,,74.1. ":44x,i d✓ 5.
❑ Plaster U Textured Coatings Othrw:
Ficcriog Mat'l
Roofing Mat'l
I Other 1401,'77 f I,GtWs ir.04:44✓e Sitell
H. Asbestos/Demolition Project Categories:
1. ❑ Owner- Occupied Residential Asbestos Removal Project
❑ Owner -O upied Residential Asbestos Removal at Demolition Project
0 Owner-O=uoied Residential Demolition Proict, No Asbestos Removal
Notification Waiving
Prniccr Fee �'��`
Period
NON - REFUNDABLE
.
Prior Notice
S25
2. U All Other Demolitions With No Psbesaos Removal Project ' '•'
10 Days
5 150
3. U 10 - 259 Linear feet or 43 - 159 square feet (se: back of form for ootioosl
3 Days 1
S150
4. U. 260 - 999 linear feet or 160 - 4,999 square feet
10 Days • i
5300
S. 1,000 - 9.999 linear feet or 5,000 - 49,999 sauare feet
10 Days j
5750
6. 10,000 - 49,999 linear feet or 50,000 - 99,999'scuare fat
10 Days 1
52,000
7. U 50,000 - 99.999 linear feet or 100.000•- 149.999 sauare fee: '
10 Days I
' S5.000
8. U 100.000+ linear let or 150,000+sauarc feet
10 Days I
S10,000
9. Emerger.cy Asbestos Project or U Emergency Demolition Project •
Prior Notice I
Twice Project Fee
10. Alternate Means of C<tmvliance for friable materials or U Demolitions
1C -Da', Review Period I
Twice Proiect Fee
11. U Altercate Means of Compliance for nonfriublc asbestos materials
Concurrent with Protect I
Twice Proiect Fee
1. 1 da heresy certify that el'.e intat:u.u.nc contained in :his noufc :trot . and suppfemencl data Jrscr bed herein. is to the ba i o: my k owteibx
acatrate and con:plctc. 1 s1r&1 cwt cause or 311o. :scutci pluicct o dcntulium activities to teen :awl the applrptiata wainng period has
elapsed
Performance
Abatement
Services, Inc
1. 1 •1 /
4 1
•
linen �•.,.,�
1 • .. 1
• ' Catagel Shod ,.- .._..•I A
• •. ,,,� 1 1fPotwir Slag
�,/'•ti1•J 1 JIh1111
r. Nur).•ry l- . • _,j Iwo 1rre I
• ilehtis
-t
■
`OrR1Cf
J l G
Nursery,)
GM tit
1• J
r •--ti
cri
71.0'
Parcel 3
r -+
1 1
1 1
She 1_ 1
(Cogd parrl>7
1 �
L.-.
p
- I
- 1
ta
1/
Open
r`
1♦ 1 1
1 1
\ ., ♦ 9,10'1 .........I CarAQf i ! /- 03
A�� '•i•' �-'� .
litirk14111PCD
1
It
... -•—•' . r-r(1\3� "� /.• '`!.
. -s .-' ----
• • • „ ,„ _ Nolo: hi I��rtion �( nil f:oluro� shown err at prnlirnotc. •
Qcm- 24 -97 12 :oeP W ,onvi77e Family Furl Ct
EXECUTIVE SUMMARY
: -6S5 -5694
Asbestos- containing material (ACM) was identified at the Tukwila Property as follows:
17120 �i$rrr.itiji ( r F.S X10; 1 Friable :ondit*
& 7140 Grady "1,400 ft-.. IS% C No Poor
Way "Farm House" 7120 Grady
& Garage Way
'i.>zi�s.i53
( Lsa:;,is:.r,
Tr ,r:sitc
Shingles
7140 Grady
Way "Farm
House"
Sink
UrV V • coating
7120 Grady Way:
Kitchen
1 sink
Vinyl Fl6oring:
tar.
7120 Grady Way:
Kitcl:zn
Vinyl Flooring
and Floor Tile
7J00 Grady Way:
Throughout
Structure
`100 fc2
ft=
fo0
100 lin. ft. 50% C
20 ft= 10% C
Ducting Joint
Tai;:
7140 Grady Way
"Fare: Hau;:,":
Basement I-1VAC
Ducts
Boiler
Insulation
7140 Grady Way
"Farm House ":
Basement
o.src
Overal. =
(2S%C
Overall
2 % -.4 C
IN'0 Fair
yes Fair
No FairiPoor
Yes. Poor
Yes
Poor
Flooring
7140 Grady Ways
"Parrrn 14cusc" : 2'4
Fi. Bedroom
Vinyl Floo :in;
7 160 Grady Way:
T4 E. and Kitchen
9" Er our n Float
7160 Grady Way:
Garage/Office
20 fr:
1
s0 it'
150 ft
Overall- No
?0% C
1 >1.0% C No
to Overall =
24% C
10 rail=
Ui. C
Na
Fair
i
Tut.w•iis Prc;prrty
J »mi!y F!n comer
P.03
Ilxe:.j :i %•e Summary
p g` Z RECEIVED
CITY OF TUKWILA
NOV 1 21997
•
A.:. L..: F4
• ;. •. ' • . i . r •: •^.A■ +11.r..a • •'t'.'q,, �•� .at• :•.r ,. .t.
•.,:,- •, ,... -.. ''.1 -,,. ''F. •'•r- '•i ' •• ' , .. ""•.•�. t,'.'. .• '%.. x.•.%•; e.;; ;... •.: •
Pict- 2�i -97' 22 " :' " -, ;t-, :,
•09P W1 y rev! 17a Fam!Ty Fy:- t:t SQi �`SS5 -9y.; 1••. :; •
•
•
•
•
•
Trarsite Panels
• t ..
Boiler Pa lcg
Material
Riverview Dairy:
Cooler, Al? •
Ceilings, Flashing
Riverview Dairy 20 ft2
•
1•
20% C I`i» Poor ' -
i.
Yes
R of Core' : , Riverview Dairy: '4;000 fr
s. .1;r •: r. Flat Roof • -
a71:"..; t • ' L • �.5 ."'. y - l t
Overall =
55-c C ..'`
Pocr
{
Iti'•: Fair
f .,. t.: t „,: .1-...'.. ..
•
C= Chrysotile. A =A.mosit. , Cr =C :ocidolite
•
e, layizveo ey
•
Tukwila Prr :riy
Ituish Family Fun Cancer
• ..O •74:.1 H •. . r5 •
•
.y • 1 II.: •
Et::u : ec Sumrts:ry
F' -p= I RECEIVED
CITY. OF TUKWIIA
NOV 1 71997
Department of Labor & Induseies
300 W Harrison St
Seattle WA 95119 :081
Phone: (206) 281 -5473
FAX: To Regional Offices
72 /c
NOTICE OF INTENT TO REMOVE OR
ENCAPSULATE ASBESTOS
THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 DAYS PRIOR TO THE START DATE
COMPLETE All APPLJCABLE BOXES • INCOMPLETE NOTICES WILL NOT BE ACCEPTED
1LcBFcTnS 4B kTFMFNT PRn_TFrT
Amended? ._. Yes Li No
Emergency? it Yes :i No
�] On Hold? Li Off Hold?
S'ONTR &CTOR INFORM 4TION
k._... ._._.....
Work Shift; M T W Zh F L kn
it X
taut ante: 7 am - 4 pm
1/ X43/97 3pm- 12 am
Completion: ' 11 pm - 8 am
\,// //7r"
Work Shift and Project Dates must be exact
Company None
dam:scar Cat. No.
(Praned Name) /
'bone No
(J ) 901733
fix
h'M
?Rf1PERTY mrsT.R INFORMATInN
Name
41, 1 /U6 i! i S 4 AO.% /c,u 67ex
Adtirss
Phone Iro. 916 Z/
(2c4) S93- / /s✓s�
//-71,/ hi4uu/447
Owner's Rep.
/rIQ . /VW 7s 4
Address
Jon Site C.A.S. Phone No
�o F eo1 /aC '- o cc-if 5 93 --
Job Site
Add=s
w
// yo � 624c tc2
City
ZIP r4
County
War
pRO.IFf T INFORMATInN
Type
Facility
WA Age
TO BE
t ale
o yew
cuo
/Z■0 I xJ Indoor? F..:_.1 Outdoor?
OU14NTITY OF 4CRF. Tn3
►/ REMOVED, OR I S ENCAPSULATED
/vo
No. /coo o sq. ft.
each box be.
elow
— fireproofing
:_j popcorn ceiling
CAB
I� sheet vinyl
ZNT•7
boiler insulation
:i duct paper
No. _ in. ft.
0
Li air cell pipe insulation
:- r,41,0, 7e' .f4ieff/e I
Om 41/
/3741/e4- 0,4647. JX!
each box below
mag. pipe insulation
cement asbestos pipe
-rRnr ( 4s ES aNI) PIPE
each box below
neg. p. enclosure
glove bag
al mini enclosure
wrap & cut
wet methods
each box below
_._] 1/2 mask APR
full face .APR
yr j PAPR
RECEIVED •
CITY OF TUKWILA
NOV 1 2 1997
PERMIT CENTER
Type C continuous flow
j Type C pressure demand
HEPA vacuum
fflikraie / res eX
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER M
PROJECT NAME
1160 Gray Wj s
REPARTMENT:
i ��j
D NG DIVISION El FIRE PREVENTION l--!
PAUBiiC WORKS ^ S 1cTVAL [�
tat
DATE 11 3
97
DIP
PMNIIr G DIVISION UU
P RMIT COORDINATOR .
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE ii 1 101 qr%
COMPLETE Ni NOT COMPLETE El NOT APPLICABLE 0
COMMENTS
TUES /THURS ROUTING: PLEASE ROUTE Ej NO FURTHER REVIEW REQUIRED El
ROUTED BY STAFF U (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS: (ten days)
APPROVED 11 APPROVED W/ CONDITIONS ❑.
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) 0
CORRECTION DETERMINATION:
DUE DATE
APPROVED 11 APPROVED W/ CONDITIONS Li NOT APPROVED (attach comments) 0
REVIEWERS INITIAL
DATE
(Certification of occupancy required. )
PLAN REVIEW / ROUTING SLIP
ACTIVITY R 0(9 �
PROJECT NAME
DATE II
3197
1160 crop -y Wy S
DEPARTMENT:
BUILDING DIVISION 1 FIRE PREVENTION PLANNING DIVISION 0
PUBLIC WORKS D STRUCTURAL ❑ PERMIT COORDINATOR Q
DETERMINATI N OF COMPLETENESS: (T,Th) DUE DATE 11 11 q7
COMPLETE NOT COMPLETE NOT APPLICABLE 0
COMMENTS
TUES /THURS ROUTING: PLEASE ROUTE fl NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF rl (If routed by staff, make copy to master file & enter Sierra.)
1
DATE Vk r ♦ -7
RED INITIAL
APPROVALS OR CORRE TIONS: (tea days)
APPROVED n APPRO D W/ CONDITIONS
REVIEWERS INITIAL
CORRECTION DETERMINATION:
DATE
DUE DATE Ill?OL97
NOT APPROVED (attach comments) 0
DUE DATE
APPROVED n APPROVED W/ CONDITIONS 111 NOT APPROVED (attach comments) 0
REVIEWERS INITIAL
DATE
(certification of occupancy required. __ )
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER MISigumak Ot9 q__
PROJECT NAME
DATE
1 so Goa . y Wy S
DEPARTMENT:
BUILDING DIVISION El FIRE PREVENTION ■ PLANNING DIVISION
PUBLIC WORKS ❑ STRUCTURAL ❑ PERMIT COORDINATOR ❑
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE 11 ij 1a
COMPLETE ❑ NOT COMPLETE ❑ NOT APPLICABLE
COMMENTS
d
TUES /TSURS ROUTING: PLEASE ROUTE ❑ NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF ❑ (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL /114
DATE / i' (a" 97
APPROVALS OR CORRECTIONS: (ten days)
APPROVED f l APPROVED W/ CONDITIONS ❑
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) ❑
CORRECTION DETERMINATION:
APPROVED ❑
REVIEWERS INITIAL
DUE DATE
APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) ❑
DATE
(Cecriticsdaa of occupancy required.
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER 1q"1- 09
PROJECT NAIL
DATE
DEPARTMENT:
'11
so Gro►
BUILDING DIVISION ❑l FIRE PREVENTION ❑I PLANNING DIVISION ■
PUBLIC WORKS ❑ STRUCTURAL ❑ PERMIT COORDINATOR ❑
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE ❑ NOT COMPLETE ❑
COMMENTS
DUE DATE I 1 IP ell
NOT APPLICABLE ❑
TUES /THURS ROUTING: PLEASE ROUTE E NO FURTHER REVIEW REQUIRED El
ROUTED BY STAFF l J (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS: (ten days)
APPROVED ❑ APPROVED W/ CONDITIONS [XI
REVIEWERS INITIAL 2J1O
DUE DATE
NOT APPROVED (attach comments) ❑
DATE I1-11-I`97
CORRECTION DETERMINATION:
DUE DATE
APPROVED ❑ APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL
DATE
(Certification of occupancy required. )
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER 1%A_PC:raP b g c DATE II
PROJECT NAME
I GO Cara
DEPARTMENT:
y wy s
BUILDING DIVISION ❑l FIRE PREVENTION ❑ PLANNING DIVISION ❑
PUBLIC WORKS r STRUCTURAL ❑ PERMIT COORDINATOR ❑
DETERMINATION OF COMPLETENESS: (T,Th)
DUEDATE IlIb197
COMPLETE fl NOT COMPLETE El NOT APPLICABLE ❑
COMMENTS
TUES /THURS ROUTING: PLEASE ROUTE NO FURTHER REVIEW REQUIRED ❑
ROUTED BY STAFF 1-1 (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
t
DATE
APPROVALS OR CORRECTIONS: (ten days) • DUE DATE
1
APPROVED ❑ APPROVED W/ CONDITIONS NI NOT APPROVED (attach comments) Q
REVIEWERS INITIAL
DATE II, lC/ q 7
1
CORRECTION DETERMINATION: DUE DATE
APPROVED ❑ APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL
DATE
(Certification of occupancy required.
City of Tukw , ay; Mayor
Fire laeaa, trnefit Thomas P. Keefe, Jqm Ode
Mr. John Huish
c /o.•Family Fun Center
1.1.55 Graves Avenue
E]. Cajon, California 92021
Dear Mr. Hu°_sh:
We have determined that per Uniform Fire Code 103.4.5, the
buildings located at 7100 South Grady Way coneitute a hacard to
public safety and need to be demolished. ,
Please have these buildings demolished within 14 days. A
reinspeccion will be conducted at that titre. If you have any
questions regarding this issue, please call the F ire Prevention
Bureau at 575 -4407.
Enclosed you will find a copy of Uniform Fire Code 103.4.5.
Sin erely,
/41.D.4-t-4-7 ,
Chief Thomas Reef,
cc: Steve Lanc3n ter Planning Department
Headquarters Station: 444 Andriver Park East • Tuk vlla, Was,`URgton 08183 • Phone: (206) 5754!&74 • Fit. (246) 5
EIVED
TUKWILA
Nov 1 2 1997
••••••••' ,,,
4— DETACH 10 DISPLAY CE11 IFICATE-4
DEPARTMENT OF LABOR AND INDUSTRIES
,?..;,'$..e,:. i f:,
• % .i.'...4'‘..., ....i.,....7..:•.4
, d•. ,...,... ,., •
*..LEt ',..:8:.•itof■Sit.0,1t:Pit,,;
P0 .:P0*..:•6:.6.5111',...'''',- ..-',. : •••••• '4..:.:1:
$.,gA:VT.1;.,'4*:.W.ki 9846
• ..•.::::...! ;:•:....:,7:•:::.. ' ' • :0:.
•:.:
:::.:.:'...,:•":,:■• :‘.. .:': '
-16: tit
STATE OF WASHINGTON
L.. DETACH TO DISPLAY CERTIFICATE--t ' • 1101111 •
F625.052.000 (3-92)
rNY,91•%7 • • '
, , t •
'4.4 -4 • • • •
;i 4 " '4 4 • '4 'Pk% 4 .4.4-.740•••••■ •4 4.4. 4. 4-4 4 '4 ••••• .• • * ,,,,,, .0 • • **************
Seattle-King County Department of Public Health
■it 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
'HECTOR OF PUBLIC HEALTH
DATED JANUARY 1, 1997
BY
,r.
SUBJECT TO ALL STATE LAWS. COUNTY BOARD OF HEALTH RULES AND REGULATIONS, AND/OR CtTY 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.
"14
, ,
,,,,,,,
,, • ,,,,,,, ,,, , • • * • . . • ... "
1%k•- •
r‹. • • • • • •
••••• tfih'. .. • .,! '"! .`-re51 ' • •
•04.10 4V0V•400‘V441.4•0■40.4taliliii • 1441; . diA'A • • p. . a!
. .
OPERATOR SIGNATURE
• .......••••••••
0601 ••■1
,14
RECEIVED
CITY OF TUKWILA
NOV 1 2 1997
: •;•. •
.......1•■•-•Itare,........11•ISMI,,,••••,101,,•1•44/41,141.104,44/1,1.-{4.50(1`!!.WS'efteTreW,MOTik'Xr.M17,•T!..“
:•• •
gltlfer ' • T.
••,,
•.
' ......• ••'''•%;:...,',%
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