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HomeMy WebLinkAboutPermit MI98-0108 - BERGSTROM SUBDIVISION - RESIDENCE DEMOLITION98o!n� 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: 115720 -0190 Address: 14921 57 AV S Suite No: Location: Category: DEMO Type: MISCPERM Zoning: LDR Const Type: Gas /Elec.: Units: 001 Setbacks: North: Water: TUKWILA Wetlands: .0 South: Sewer: Slopes: Permit No: Status: Issued: Expires: MI98 -0108 ISSUED 09/04/1998 03/03/1999 Occupancy: DWELLING UBC: 1994 Fire Protection: N/A .0 East: .0 West: .0 TUKWILA Y Streams: Contractor License No: EASTLUI178CM OCCUPANT BERGSTROM MARY J 14921 57 AV S, TUKWILA WA 98168 OWNER BERGSTROM MARY J 14921 57TH AVE S, TUKWILA WA 98168 CONTACT MIKE DAVIS Phone: 253 874 -0694 900 MERIDIAN AV E #19 -313, MILTON WA 98354 PROJECT BERGSTROM SUBDIVISION 14921 57 AV 5, TUKWILA WA CONTRACTOR EASTLAKE UTILITIES INC Phone: 425 - 868 -7836 20117 142 AV NE, WOODINVILLE WA 98072 ***************************************************** * * * * * * * * * * * * * * * * * * * * * * *k * * * * ** Permit Description: DEMOLITION OF EXISTING 1,150 SQ FT SINGLE FAMILY RESIDENCE, 380 SO FT GARAGE AND A 576 SQ FT ACCESSORY STRUCTURE. WATERLINE AND SEWER WILL BE CAPPED AT THE PROPERTY LINE AND WATER METER WILL BE REMOVED. **************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Construction Valuation: $ 9,000.00 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: N Public: N Storm Drainage: N Street Use: N Water Main Extension: N Private: N Public: N **************************************************** * * * * ** * * * * * * * * * * * ** * * * * * *** * * ** TOTAL DEVELOPMENT PERMIT FEES: $ 46.50 ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 1***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * ** Permit Center Authorized Signature: Date: 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 ate or local laws regulating construction or the performance of woj . /Y -i •• horized to sign for and obtain this development permi Signature:___ Print Name:_ Date: "/ -q'' l,3 This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. CITY OF TUIKWILA 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 mall or facsimile. Project Name/Tenant: n� Value of Construction: q,.c� .L. ar r �5 a , t ,�_m� `"'^^== �15'�.(J y �CGity Site Address: State /Zip: 111 -il� !�)9z1 - 57 Hi dot Tub � Tax Parcel Number: 115720 -0/90 -05` Property Owner: /i,'v ' ��( t_i ►r 4o rn Phone: 20(- 2gb -59v t,/ Fax #: 20 - -82Wy Street Address: City State /Zip: Boy PUP/ � la�,le�� 9�/b9.612V Contact Person: ni I� /'Z,�, 1/ /'I I'� t>/T'� 'Phone: 25 3-67L1-116f9 Street Address: City State /Zip: Do in i / ,, AvE- A167* *173/3 Mi)Jn 1193S9 Fax #: 253-67V-5291 Phone: Z53- $'6 3-770 Contractor: �n�J 4 IA' P4 /in'S - 4-ee 1 c%ptlr. % Street Address: City State /Zip: a x 4 s! iLphinfie 9A a Fax #: z -3 - 6 3- 7 776 Architect: Phone: ---O r..— A --g- Metro tandbp- ---- -_ Street Address: City State /Zip: Fax #: Engineer: N/A— Phone: . Street Address: City State /Zip: Fax #: MISCELLANEOUS PERMIT REVIEW AND APPROVAL REQUESTED: 0 BE FILLED OUT BY APPLICANT) Description of work to be done: r r o f" ; d)AL-5 Will there be storage of flammable /combustible hazardous material in the building? ❑ yes ❑ no -1Attttach list of materials and sto ra a location on separate 8 1/2 X 11 pier indicant-1 uantities & Material Sa /ef Data Sheets lJ Above Ground Tanks 1U Antennas /Satellite Dishes Bulkhead /Docks Commercial Reroof III Demolition ❑ Fence ❑ Mechanical ❑ Manufactured Housing - Replacement only ❑ Parking 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 in Sanitary Side Sewer 11: ' ❑ Sewer Main Extension 0 Private 0 Public ❑ Street Use ❑ Water Main Extension 0 Private 0 Public 0 Water Only Size(s): t'AP( /1O(. Size(s): Size(s): Est. quantity: gal Schedule: ❑ Moving Oversized Load/Hauling 0 Deduct MONTHLY SERVICE BILLINGS TO:" Name: Phone: Address: City /State /Zip Q w taf- ° ---O Sewer --g- Metro tandbp- ---- -_ WATER METER DEPOSIT /REFUND BILLING: Name: r- Address: Phc 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 �:�. 98 Applica (Initials) I AL•. MISGELLA1`:FOI'S PERMIT APPLICATIONS MUST BE SUBMI ED WITH THE FOLLOWING: )> A L DRAWING ALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN ➢ BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED ➢ ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT ➢ STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED STRUCTURAL ENGINEER ➢ CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CiViL ENGINEER (P.E.) Copy of Washington State Department of Labor and Industries Valid Contractor's License. If not available at the time of application, a copy of this license will be required before the permit is issued, unless the homeowner will be the builder OR submit Form H -4, "Affidavit in Lieu of Contractor Registration ". Building Owner /Authorized Agent. if theopplicant 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 submlt this permit application and obtain the permit will be required as part of this submittal. I HEREBY CERTIFY THAT 1 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 O Hp ZE 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 Noi.`: M79 , ri Antennas /Satellite Dishes Submit checklist, No; M-1,-, Q Awnings /Canopies -• No signage. - Commercial Tenant Improvement Permit ri Bulkhead/Dock • Submit checklist; :. No: M -10, . 0 Commercial Reroof.: Submit checklist : No: M -6` ;; r}- Demolition Submit checklist No; M -3, .. M -3a 71 Fences - Over 6 feet in Height Submit checklist' • No: M -9 0 Land Aitering/Grading/Preloads Submit checklist : - No: M -2 0 Loading Docks Commercial Tenant Improvement Permit.. Submit checklist: Noi H -17 ` 0 Mechanical (Residential & Commercial) Submit checklist.... No..... M -S; Residential :only.: H -6, H -16 . Submit checklist, ;. No: H -9 0 Miscellaneous; Public Works,Permits 0 Manufactured Housing (RED INSIGNIA ONLY)` Submit checklist • No: M -5' 0 Moving Oversized Load/Hauling Submit checklist •.No: M -5 0 Parking Lots Submit checklist , No: M -4 0 Residential Reroof - Exempt with following exception: If roof structure to be repaired or replaced Residential Building Permit Submit checklist No: M -6 Submit checklist , No: M -1, d Retaining Walls - Over 4 feet in height 0 Temporary Facilities . Submit checklist No: M -7 . ri Temporary Pedestrian Protection/Exit Systems • • Submit checklist.. No:' M=4 • ri 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 theopplicant 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 submlt this permit application and obtain the permit will be required as part of this submittal. I HEREBY CERTIFY THAT 1 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 O Hp ZE G Signature: .."'""4- ( Date: / ,,. /d . 1,2t ! Print name: 7 Phone: I Fax #: Address: City /State /Zip: Akm CITY OF TUKWILA Address: 1.4921 57 AV S Suite: Tenant: Status: ISSUED Type MISCPERM Applied: 06/10/1998 Parcel #: ] 15720 -019t1 Issued: 09/04/1998 k• k************' k• k****' k********' k******. k***** *** *'k•k*'k***'k•k•k''k•k'k ** *•4'4'4.4 ** *'k•k * *•k* Pernii`t Conditions: 1. Temporary erosion control measure, shall be implemented as the first order of business, to .pre.v,ent sedimentation off- site or into existino.,.stk dra1na :e 1~a ilitie:. 2; The site shall have �+e.r'.iii'ane "nt ero ion °c O }) meas Ines in place as soon as "piis yi'b 1 e :af,ter f i;ha l ar�ad i'n "°` `r. ; ;� 11ths been completed and;fit:i:or tub th,c�' Final 1nspection,:. 3. ALL CONSTRUCTI N AC IVrlY`'.;ASt0CI°ATED WITH xT IS DEMOLITION. SHALL BE LI`tWED " =Tc WITHIN 10' OF THE BUILDING ='EX TEI IOR 4. 'SANITARY,-''SEWER ''SHALL1 BE PLUGGED' AT THE PROPEPT,Y. LINE 5. WATER SERVICE ".SHAL•L BE`CAPPED AT THE PROPERTY LINE,:, CONTRACTOR SHALL COORDINATE'WATER`.,METER REMOVAL :WITH,,; CITY NNLER SHOPS,,°'CONTACT;'; MR DAVE .GREGE @ (206)433-3863. HOWEVER THI_ WATER SERVICE `;HALL BE CAPPED AT THE MAIN .. AT THE TIME .WHEN CONSTRUCTION ,OF'' A NEW WATER SERVICE,,,FOR BERGSTROM''WATER SERVICE STARTS. 6. Remove a;11 Weeds. concretes'' stone foundations, flat c:qn ,x cret'e, concrete patios.';rnasOnry wa :�i.ls',v � gciraae floor ~s.,'go.r. ve, waVsand s ;imi;lar, structuresl and a1l 31oose isce1lariemis ' marial Proper Ly cap an 1 tarv`e,WP ` an d. :. water• corinee, prcper�ly- ,fi : :11 or `.other.wise, prose :ct - all basement: ce] Lars: ` sept;.i c "tan :s' we:ll s ;;'and' others excavation,, �, Val i a i tv '`at Permit Tile isua "rice f a . permi t or approva.i,„ o plans, pecit cations, anti cornputat ons "s.haT1 not be con- -1 ..tr�ue,'d: to1.be aa permit for , or an ,apps ova °1"' ""ot,t anv viosat1on of arl,v Of, .the `Provisions of the }buitl,dtin0 code for° of anAlS other .,'or din;ance ,of, the jurisdiction: itoo ° ?pe 'niAt pr a tri ng giveautho'r�ity to violate or cancel the p,r'ov,llsions.• of this xyy Permit No: MI98 -01081 code shall be valid. ; i t�. PLAN IfE'V1EW / NP ACTIVITY NUMBER: _ M198 -0108 PROJECT NAME: BERGSTROM, MARY J. ml: Original Plan Submittal Response to Correction Letter # DATE: 6 -10 -98 Response to Incomplete Letter Revision After Permit Is Issued DEPARTMENTS: Buin Don —rivisic- Ply I 1 `6 X NO Fire r v ntion Structu al rt la, n n Planning Division ❑ Permi oordinator DETERMINATION OF COMPLETENESS: (Tues, Thurs) Complete n Incomplete Comments: DUE DATE: 6 -11 -98 Not Applicable ❑ TUES /THURS ROUTING: Please Route No further Review Required Routed by Staff ❑ (if routed by staff, make copy to master file and enter into Sierra) REVIEWERS INITIALS: DATE: APPROVALS OR CORRECTIONS: (ten days) DUE DATE: 7 -9 -98 Approved Approved with Conditions ❑ Not Approved (attach comments) ❑ REVIEWERS INITIALS: DATE: CORRECTION DETERMINATION: DUE DATE. Approved ❑ Approved with Conditions ❑ Not Approved (attach comments) ❑ REVIEWERS INITIALS: DATE: \PR•ROUTE.DOC 6/98 M► 4?-a/C g. Y„ 6 0 .4.thl``"s14g;G'ff'.i'rrie :reelifetefticibrt Fri?OntIs, act INSPECTION RECOr Retain a copy with INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188- Project: _,, J. Type of insp: tTon: __ AI -r, Address /y `�/ Date calla e re Special instructions: /c -1.t.Lo S Date wanted: G/Zaf Requester: Phone No. ,e6 .. 9,9cF_ 99.,7,7 pproved per applicable codes. COMMENTS: Corrections required prior to approval. Inspector: Date: $42.00 REINSPECTION. EE REQUIRED. Prior to inspection, fee must •. be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection: INSPECTION RECD Retain a copy with p INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 rizci 8 - 0108 ProjeAt: ! Del.:.7` Tr, .. PIg� Type of inspection: �// 5',..� - O sCaNac'c -* Date called: c/— /7-96 Address: /i/9./ 57 40 S Special instructions: Date wanted, 7 -/ 7'98 a.m. Requester: Phone No.: 2 No.0G:, 7.73 - 67 99 Approved peer applicable codes. COMMENTS: Corrections required prior to approval. V.1 r i l ? P SfuA Ivo ivy b- ( 444 A 5s/r 7/ IInspector: Date: 17/$-g (_J $42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd.,,, Suite 100. Cali to schedule reinspectiion,. 1 rt , r* 4: 4A*: 4k * * **AA•A* * * *:4h * *•k * *A;4*A•kA . *• * •ih;!•k;4,1kV •k• *4:4?4•fi:k*•4*k,1•kk CITY. OF TUKWIL.Fi. 41A j.. "" j TRANfiM T. . *fir hA*A !:yk1 A *•Ak•.1kA***•kA:4. . 4k�!* AA•;l h: 4• fi*• A• A• hA. A •J4 * *icfik:4h•Ak•A1�h;4A•k:!••,1 '• 1 RANfiMTT :Number :. R9700025 Amauht: 46.50 09/04/9S.,,1,000:. Payment Method: CASH ' Nota•ti.on: MIRE; ,DAVIS brit0K iP Permit No MI913 -01O}3 Type :: MISCPERM MISCELLANEOUS PERMIT Parcel No 115720-0190 Site Address 14921 ;y .AV Total Fees,: 4610 This Payment 46»50 Total .ALL Pats. 045P Balance::, ., .O2il .. *is* A*** *A* ** * * *l( *k*A *A,4, “ *+.'• *AA*.* ark * *.4 *•k *k*tltlai k*'4,44,h*Ayl• **: Acr.runt Code ' 'i)ego.riptio►'r Ainount;.. Q00/322.100 'CIUTLtl1NG 7 N0NRS 4'2 00 0001 8 ,':l0':{' STA•f.E 13U`XLDI.UG.511RCH►aRC7t 4;.50:, erC' n•• -AO iAA : rI1 ',rnrAt:'; . f: 1 .. r.. ■.u. 4 J 13.IJO F.S. & GS SERVICES PAGE 81 Agancy Cis. Mo. aC37LIt+ Aim' 1/IM Olit• PUGET SOUND AIR?OLLLITION CONTROL J■GENCY Date Received .- 1 10 Utlioo Saws. Suit/ WO. Sasls. WA 911014031 NOTICE OF INTE,N'r TO r»0."It: lPU) *tit Tvpa: L Aaburvoa Kuala Crortair Cam.. i3, iL srnd■•"- Armco ilia asiv Asbesroa R*mo•a Asbestos itscprral At Drarsailtiors 3. * Decaolitlest. P4. clM klJu � L A 8 ?y- oh 4y Sty: w�. 2 i 58t /B ,y• _ t4V V _ "Zee' posit c:sav, ati gesso raw Jw%m« 10/4 04 4A..s. C.oeffaCeat O tilin,r Altirras: gO i1!�i.i�� 1 I Z.''* Sr: `, 5w .>..,. 4.11 ∎••∎� ► _ `�..i_ �.._ I zn:'Mi 7) •r�.r ... �. ■ ! • ■ �i! eo_ c ' 'S) _ • 330 + �..._.. 4�h ._ �. —.�.. al') 1 y li -1)0 ...—'I- Coacr1c:or Job No.: �)i �% v- 1 L l 1 ! Stave: W �► 1 ,►dcl:e�t: )��. z1 S� .�(iL Si. Ctr �-�► I Scnc _ W/. I Zo:rJ$f'� 31W. :vlauag• or, tit= Peron: IN11k.C. 1�! Survey or No. of IM D Stingy was © Ntat'l t►d: I Sauc:urra: Conduetd. 7 ' Z3 Building •rxr Name: !bout: (6-3) 8? • 04 Q y Demolition (► o. of lafortawtioa: 5 cures: -�' 5tact Cate: Waa Aib s s hound? `!:z 0 ti Yo. AtTaCh Sung.) Expiration C.:xtificuioa Yo.'t�Ofs Date: S =L3 .95 - TTtaiiu' xe Mist Firs 1 as demolition c ntrae :cr betowi� 10 •era I 0 Ortic:ed DrriCliuOn cz0v of Ordezl Dcmalicloa j PROT I•ra %Cac tirriA wir11.Z G MIOSALi a £OX 1 G. twat .r fllw:ww to aua irraI 'VII aryr. OW Coucrncwr. I `Y' l.Ak Pxooe: { . •) ea - 7634 Aabesso. Pra j.ct No. of Scruc:ures: • tar: lnto MLA rloa: f rs .. 11 t Dace: sal Cu.ndty to be Rut:lova-A: Linear Fc. "143 i erms1 Swum Insulation: !.Jac. • • Mar L• 8oil+ct" .uwac lux. F.naaroodnq P•siae es4eat Ploe sc. N.lae!: 1 cameos :4. -901colatuggplitiojh auar: r. •10 7 Duct tus ilea ltu. Ptuzc i maul Piooriott Marl I *win 11ousti 1 OttwsG Sa Su Will all aabe.iai tnalerlal t,n.• V ,. • • j.., . , . Asb.doaWD.&i L Man Projecs Categorise: ly —,' . 0 Ow1s;.Ccaapied. Siagic•Fa ty Mild:w :Asbetae a:movsl ?:o.c: S'mile.FitniRcaiduncc . arson P:owc. 1U1 Othwt ' De nellRO�With Yo �tbestoa • Qsm,gvt� = �:9 Ui w' 4i 1 9 mare finesse 'neck ni :ova for is rts1 j v 1 . ' W-So-' Prior Node to Ores N- a ems . 5:.! _ 31.!0 3 Daw 1 10 Days 1 3 :CI :00 till 2�J • 999 llns�e • or 1609 saws ie•: ��__ . '� 1.000.9.999 Wse�r feat of 3,000 _.. fat re feet - 1 • 3 . SO _ 10.000.49.999 lint �e:r oor 50.000 - 99. 99 f=t _ _ 10 Oays j 5:.000 _ !0.000.99 w linear feet or 100.. --14i9.•'',3.000 :�: ��• - ■ LO Da_ 1 SIX() .._. 100 inc.- r or: or 1:0.000* rauaro !Ire I 1 w • ays I i0.000 .��E e•' : 4 % . s s a -aiett or Q E i t i Damuliaon ?'!tliW 1 P ! No ce ► Tito: Prover: Fee I 'J +. cersate1l of Camolinnc: for1nAble piaterals or ' Cmolioo I 1 10 -0nv Rene.. Pen co 1 air i ,1r with P!'0 kV! 1 Twiea ? -4114_: ree T•riea P!ntect tee : 141'(111* ldeaa>i of eimoliAnce liar lnsnin,la =atom= "MAY, Al, ,w6 ycYSty awtt• aim y. Ainrrttsaaa aapq+ari w ass mods:aura. sr/ a tiqui«..rt kiass d.statiaA *IMO. is as r hsa .1( SI bi600 3t:euaa aid a...prns. 1 dull lot ewer ar sitsw ary asYesas 7tepc >< rmttiisss b.fit1 east va +r} nm i1�i :+itiwa ter whtwwL „vas is•►.�ssy„s out ✓4 rs. J ul. •J•1. 09/04/1998 08:27 253 - 848 -3308 F.S. & GS SERVICES PAGE 01 08/26/1998 13 :88 253-848 -SARI r.5. a ua acRviuca 1��•- : pine: Sound Air Polludon Control Agent'', MAMA) is the !oval air pollution authority ft. ,t King. Pierce and sap Counties. PSACA's Regulation 1Z. Article 4. requires advance notification be submitted to PSAPCA. on Age:tey- sroved focus no. 64460 (Revised 10196). for any asbestos project involving m4&erials equal to or pester in size than 10 lint =: or • $ square t*.t had for any demolition project. regardless of tsbescos content. involving struchoes with a prvje;:ed roof tZ mare than 120 square feet. Nodces of intent should be mined or hind delivered to PS.I.PCA (addmss oa re ie;se side) th the appropriate project flee. A PSAPCA tepreseaterivs'N1 review the aatificatioa sod if it is completed correctly a copy 11 be ersonsead by men within 3 td' days to the wailing sddtess aimed in box C toad box /. The temrned copy will be your lid oodtlesdoe. memos: 240//1 1'e "t6- r. N- C. L • .It ••• •1•-• •- • w • •.• 4 •• • • I tT • • phone:( /t$) 8 -783 8S- 3 t•Wnra.c s Job 0: GUIOI UNR$ FOR SUBMITTING A NOTICE OR !WENT Enter all applicable information accurately and completely. incomplete Notices of intent Will he returned. lox A. Cho sc the approplam prep= type. lox B. Este: the legal property 0W202 information !ox C. Earl the asbestos canter or intotmadon. or not aopilt:Ale" (N/A) for de:noliticn projects when no antes ;cs - ::,ntiinin3 materials sr pram. Tor an Owner Occupied, Single•Family Residence asbestos removal project (project i gory Bl), BE tree asbestos removal coatrsctor or proper; owner doing the asbestos removal (Include property swner's =Mail addreet). 3os D. Este the ubeaws =oval or demolition Site wrest. Tor as Owtter- Occupied, Single- Family Residence asbestos re:oovai project (project e;3regery l:Ci) where dut property owner's mailing address differs from the site address listed in Box D, a letter must acemp ny the Nodes of Latent rev tyi&g thee the structure located at the site address Is currently being used u the propel!► owner's domi le. Multiple as, csris/demolidon projects involving more than one scruc:ur. (project Category El chrvu$h hl) oast be submitted in a :aedo; : v i h PSA2C.-1/4 Regulation G Secion 4.0 .1(a)( J• Bos E. Este: the asbestos survey iaiotmadon or check mare"al presumed (for sbestos preje::s only). An A.1-• MA building blste..or mast conduct an asbestos surrey prior to any demoliton t roje (Lc. the wrecking, ruing. le•'e:ing, dismantling or burning of a sQaeAtre. making rise strums* immanently uoinhabirble or unusable). Box F. Ewe the demolidotl project itttormadoe. 1T the mane is to be used in a asinine Are. fist the tare deportment rceotosibie for conducing tabs buts as the demoiltloa =M OH' in Box J. If the property owner has bees ordered to perform 1 demolition by a government ofJSees. submit a car of the or ds fret, the appropriate official. Sox G. !stet all ashes= prof : hiformarlon or a -N /A" for tezolidon ;rejects with so asbestos te:novsl required. All nultigle =cum sbestos otojecz (peejsc =Sari on F410 and it taut :e subtritt+ed with .v' k oian. rnao 'it 'he ;trlc; ire :, .otnoie ;e heal 2tLL X2i1 1 lnL 1 1bestos tmra_•.al to mmovea,tem :act st m„ik,r , ls:.estos uur'e•'. iea •vnrx i i'* ule. Ho: B• C t=ic one profs'~ touelory is boxes 1 *MOO 3. The project tie includes the demolition fee. Asbestos removaz Troje sad demolitions with an asbestos removal involving lass than 10 linear fest or 4 square fee: may be filed as project =gar! 3. Aa esnsrgssar/ asbestos project or demolldoa asset* raquesrsd by checking the appropriate job size category in boxes 2 through 9 sad then cherldag she applicable emergency, boat in e tam 9. Emecje cy asbestos proje aodtic3tuon3 cwt be submitted with a issae: fives rhae prOpeesy owoe: exptchOog its necessity for else emergency. Etat:le:iv! detnclitton aerltatioes =St be submitted with a letter flora an sutort :al government official or a ticsased strums -al a n:nee: dee:unman; that the sttucuir. is in imminent danger of collapse. To guest sn alterative roe=s of compliance for fr3bte or souasable mnitelais. cbsdc the apocupciete job siu category in addition to the aaplicabie box in categories 1.0 and t ! . A wort lists crust be submitted by as agpsrpriostly =Wed iadivideaal skin wich the socifmioa. Box L Sips the setitic>tdon =miffing du =rangy sad anopleteaess of the iefoc osiioa provided sn the form. Aos J. Ease densolative coorrar.er audios ialormeaion (on boa). 25-3 - e7 t/ - s'r` (/ / bilidnicjigighism we requia for ehome coat itteaaa* use project type. Job size categor /, she ages of asbestos t sosmtals to be removed and Work schedule champ*. No fee is required for wont schedule changes if the contruxr :a ;arm:4min' in We Agency work ubedule fax prepare. A 310.00 pocamiag rev is required for ail other amendireats. For technical assistance. contact Tom Hudson 31 C.06) 6119.16•8. Lair' v ;ugen (:06) 639 -102, or mime .Are: ;:C6) 399. a;.14. F or :nquir es owlsening nodfcoors and amendment emus t.encc: Anne Mor eo sc - ::6', 539.1;94). 09/04/1998 08:27 253-848-3308 l F.S. & GS SERVICES Puget Sound Air Pollution Comroi Agency 110 Union Street, Suite 500 Seattle, WA 98101 -2038 Tom Hudson: August 31, 1998 Re: Notice ofDeiiciency for the Ctrl Bergstrom project the following information is supplied for your review. The project consists of three buildings. The house, shed and carport. The following is a list materials that are to be abated. Bldg. Piaster Putty Roof House 3000 sf. 3001f. Shed House 10 sf. The house is scheduled for 9/07 - 9/10 The shed is scheduled for 9 /10 - /10 I have included a site map also for your review. Thank your Mike R Miler Project Coordinator 5520112th St. E. Suite 13 • Puyallup, Washingt Vinyl T. S.1, Board 60 sf. 2 sf. AUG-Al-98 'i:16 PM roc,1 lc. 112 I m Eriv Iron. 1MG 14921 67th Avenue S. Tukwila, WA 206 244 100.06 14921 67th Avenue 5., Tukwila, WA MU . • • ••• • : • •;•!,.. ! • 00 " " • ... 41!•f••7::•••••. . . .... . •,•• ••• .. . . • . 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' '':::': :::•::••":.::::•::::;:•-•;::::::!:: .' ••• 'oft, • •'. •!• • • • . .'• 00 39Vd S33IAN3S S9 T 'S'd 80,a808-E0 W80 J3661/0/60 17 18 19 C c E'ER DATE 20 b121 L v D 'ca—C [ (d;IP 12 - PROPOSED GRADING LIIMITS CITY OF TUI WILA APPROVED JUL 2 if 19 AS NO I is 6 `DUI L DtIC'C- C I' LEGEND TP2 (a TEST PIT NUMBER AND APPROXIMATE LOCATION S. 150TH PL. TR. A Mrts blc6 L07 /pie LC RE 1VE{f i CITY OF TUKWILA JUN 1 0 1998 PERMIT CENTER AGI TF(14Nf 1 °CIES Site Plan HBR Enterprises /Bergstrom Plat Geotechnical Investigation Tukwila , Washington FIGURE 2 City of Tukwila Department of Public Works John W. Rants, Mayor NOTIFICATION OF UTILITY PERMIT ACTION TO: PERMIT CENTER FROM: PUBLIC WORKS ENGINEERING DATE: JUNE 18, 1998 SUBJECT: BERGSTROM SHORTPLAT Demolition of 3 Structures 14921 57 Ave S. Project No. PRE97 -014 Permit No. MI98 -0108 Contact Person: Mike Davis Phone No. (253)874 -0694 Ross A. Earnst, P. E., Director THE FOLLOWING PUBLIC WORKS PERMITS HAVE BEEN APPROVED FOR ISSUANCE IN ACCORDANCE WITH THE PLANS APPROVED ON JUNE 18, 1998: MI97 -0108 Sanitary Side Sewer (capping) Water Meter (capping of water sevice & WM removal) TOTAL: Permit Fee $ z�5.--9�6- 14) 0 okkizh ya P Applicant shall obtain a separate permit from Puget Sound Energy for capping of the gas and power line, if applicable. Two copies of the confirmed Utility Permit Application Form and approved plans are attached for inclusion in the building permit file. JJS /j j s Attachments a/s cf: PW Utilities Inspector (w /copy of application & plans) Development File (w /copy of application & plans) Finance Dept. (w /copy of application) • • • j ;+ , 1,- / • ,. •� , W w � ;./.1 •;; ; W. ''' ►' °" 0A p!; '• .:..•��; :Fl ?1.5 �;. -1., • • :vs� "'r!' u }•' ,, . ti !- r .t' j f j •.rr � ar '• • ' � rJ ' .. J,,z� kJZ t 2.•�,a,�r /,1.•� •� y.• 'A\ •- :=;i'DEPAR_TMENT:'OF'LAABOR 'AND!INDUSTRIES' �•(:t ,' r ; n }.... "1! ✓ tea• .,. 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