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13-103679 r , • Demolition eWy • .{{.�� CommunityCity of&EcoFedn.ral Dev.Way Permit #: 13-103679-00-DE 33325 8th Ave S Federal Way,WA 98003 Request ection Ph:(253)835-2607 Fax (253)835-2609 p Line: (253)835-3050 Project Name: STARBUCKS Project Address: 28722 PACIFIC HWY S Parcel Number: 332204 9119 Project Description: Demolish existing building. Does not include demolition of associated improvements or removal of trees or other vegetation. Owner Applicant Contractor POLL FEDERAL WAY LLC ANDY PAROLINE WILCOX CONSTRUCTION 8915 SE 44TH ST 3617 SW CHARLESTOWN ST WILCOC*194Q0(12/10/13) MERCER ISLAND WA SEATTLE WA 98126 234 5TH AVE S 98040 EDMONDS WA 98020 Additional Permit Information Demolition Valuation 12000 CONDITIONS: 1)The demo work provides that the final grade of the exposed soils sets 6"below the surrounding paved surfaces,OR 2)The exposed soils are completely covered with 6-mil plastic,which is anchored in some manner,OR 3)Silt fence or Straw Wattles be installed along the downstream perimeter of the(old)building footprint. PERMIT EXPIRES Thursday, August 20, 2015 Permit Issued on Tuesday, August 20, 2013 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use wil� accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent ( Date: (-4-- • THIS CARD IS TO + I ON-SITE CITY OF Construction Ins ection Record Federal Way INSPECTION REQUE TS: (253)835-3050 PERMIT#: 13-103679-00-DE Address: 28722 PACIFIC HWY S Project: POLL FEDERAL WAY LLC FEDERAL WAY, WA 98003-3224 Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card. 0 Final-Building(4050) Approved By Date Rough Electrical Final Electrical Right of Way ElApproved ❑ Approved ElApproved By Date By Date By Date RECiVED ` CITY OF PERMIT APPLICATION Federal Way AUG 2 0 2013 CITY OF FEDERAL WAY CDS PERMIT NUMBER / _ l 0 3 9 _ 2 E_ TARGET DATE SITE ADDRESS ` SUITE/UNIT 4 IS4t1_ plgc,I--lc, S. PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL! $t Z,boo. aLe. 3 3 0- 0 - 9' l / TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECT —S?��t7 C—S / ✓ PROJECT DESCRIPTION G 4°c_l-i1.4 alt Detailed description of work to - _ _ - be included on this permit only _ NAME . _ W. . PRIMARY PHONE PROPERTY OWNER 47c rem"' L t,., LL MAILING ADDRESS . E.7 L .Z.Z /'RG'11�%LCr ,4 ve s CITY STATE ZIP NAME PHONE . _-L-40.."<" ex,4.--4 n>-E 4 zv'- 7-34 ' Q, &8 MAILING ADDRESS E-MAIL CONTRACTOR Z'7 4' S 7y+ 4~E S CI STATE ZIP ^ OZ FAX "-oma,a WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# / / NAME PRIMARY PHONE LL„ Wt-c>�il�c� 2© 6 • ��5, 0 3f7 APPLICANT MAILING ADD - S E-MAIL .04/ s,:Q •440 PAtivt.li-te�ts,,!o�.A rcATE caml CITY /G �vMA' zzp f /L FAX / IA _ NAME PRIMARY PHONE PROJECT CONTACT (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX NAME PROJECT FINANCING 4,1,);z3.-7 epIg.'Z.O L woe. 0 OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS, ,STA ZIP (RCW 1927.095/ PHONE 3d/q s r S (. g . •331 I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in the investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the city, but only where such claim •. out • reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the ci ' a i, is application. •—� DATE 8 ,Zd 13 SIGNATURE: PRINT NAME: t /4n"6)L'4 h'/C014 Bulletin#100—January I,2013 Page 1 of 3 k:\Handouts\Permit Application r VALUE OF MECHANICAL WORK MECHANICAL PERMIT $ Indicate how man o each t se o ure to be installed or relocated as .art o this sro'ect. Do not include e.'stin, res to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial) BOILERS FURNACES HOT WATER TANKS(Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES VALUE OF PLUMBING WORK PLUMBING PERMIT A $ Indicate how man o each t se o ure to be installed or relocated as s s rt o this sro'e . Do not include existins ures to remain. BATHTUBS(or Tub/Shower combo) LAVS(Hand Sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URIN• OTHER(Describe) DRAINS SHOWERS VAC M BREAKERS DRINKING FOUNTAINS SINKS(Kitchen/Utility) W• ER HEATERS(Electric) HOSE BIBBS SUMPS ASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR 'OR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXI ING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑Yes'❑ No ❑Yes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING, PROPOSED TOTAL FOR OFFICE USE FIRST FLOOR(or Mobile Home MEI COVERED ENTRY FAIN— GARAGE ❑ CARPORT ❑ , EXISTING PROPOSED Area Totals '�'"� ei �. 4': vE'& YAC' 4 _ -, s.. _1 1 """ ,s .. i°�:: : 7 . .;o',..1 .�IAIRI .?.x r..c 4VOR� fps -a < T;._ ESTIMATED SELLING PRICE$M11111111111111 #OF BEDROOMS COMMERCIAL-N^ /ADDITION Area Construction-- #of AREA DESCRIPTION Occupancy Group(s) Additional Information in uare Feet /.e Stories ADDITION COMMERC -REMODEL/TENANT IMPROVEMENTS AREA DESC- • ION Area Occupancy Group(s) Construction #of Additional Information in uare Feete Stories TENANT AREA ONLY ■■ �,. Ateret.,, .. ,. K!i rpt" ,.. „r,.Yta"1..k,e�,r„''u n1n x..a,.-p,= Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application • ' DEPARTMIOF COMMUNITY DEVELOPMENT SERVICES 33325 8th Avenue South .,.#1,. „ PO Box 9718 Or l Qf 3F w•-:* ,�??::� :- Federal Way WA 98063-9718 deral Way 253-835-2607;Fax 253-835-2609 v.w.c tyottiAleralwav corn DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning Division to see if the proposal exceeds thresholds that trigger an environmental review.An environmental review and submittal of an environmental checklist may be required,which will extend the time period before a demolition permit can be issued. 0 Prior to submitting a demolition permit,the following items(as applicable)must be signed by the respective agency (see attached Demolition Permit Contact List). NOTE To APPLICANT: Utilities shall be disconnected and services performed,if applicable,prior to issuance of the demolition permit.All applicable items below are to be,signed and dated by the respective agency representatives. 1.ASBESTOS ABATEMENT 6.ELECTRICITY (Copy of approval form and asbestos s rvey from Pu t Sound Clean Air (Electricity to be shut off and meter removed) Agency provided) -V��� ✓ (Puget Sound Energy) City of Fe era Wa tiding Official) 2.GAS SUPPLY \\ 7. FUEL STORAGE TANKS (Gas to be shut off,meter removed and final bill paid) (Above or below grade fuel tankseen pumped or removed arc I LAM VI '0vug NLi Lc.Twul under Fire Departrne err t pri�ffor to any dismantle/excavation) Energy) (Puget So nd Energy) (South King Fire and Rescue) 3.SEPTIC SYSTEM 8.WATER- Public Source (Check applicable box) (Tank to be removed or tank t e dfained and filled) ❑Meter to be removed and final utility bill paid o Meter to remain and be protected Gtr'C I GA fGn Dv n.1ti.►L ctlA s-s-2„ c.7'ath t 1.,i0 D (King County Environmental Services) (Water Supplier) 4.SANITARY SEWER (Check applicable box) 9.WATER- Private Well(Check ap licable box) o Sewer line capped at property line o Private well filled and capped o Existing sewer line to remain and be used by proposed new structure o Private well to be r other purposes Lvr(y 4Print 6 UvSLtt-4y Lu ¢Vcrl % l (lPnV}B (Lakehaven Utility District) (King County.Environmental Services) 5.GARBAGE (All household garbs • sed off and final bill paid) (Waste Management/Other Company) ❑ Completed Construction Permit Application form ❑Provide the following fees: 1.Demolition Permit Fee Based on valuation.See table on pg 4 of the construction permit application. 2.Automation Fee $6.00 3.WA State Surcharge $4.50 Bulletin#122—January 26,2010 Page 1 of 1 k:\Handouts\Demolition Permit Requirements 1116 • DEPARTMENT OF CO•NITY DEVELOPMENT SERVICES 33325 8th Avenue South CITY OF PO Box 9718 Federal Way WA 98063-9718 Federal, 253-835-2607;Fax 253-835-2609 www.cityoffederalway.com DEMOLITION PERMIT CONTACT LIST This list of agencies may assist you in expediting the demolition permit process.Refer to the demolition permit requirements for signature blocks.All applicable signatures are required prior to permit approval. 1. Asbestos Removal: Puget Sound Clean Air Agency 110 Union Street,Suite 500 Seattle,WA 98101-2038 206-343-8800—OR—800-552-3565 www.pscleanair.org 2. Electricity: Puget Sound Energy Tacoma Public Utilities Attn:Construction Coordinator Customer Service 22828 68th Avenue South,Suite#102 —OR— 747 Market Street Kent,WA 98032 Tacoma,WA 98402 888-225-5773 253-383-9600 or 253-383-2471 3. Gas: Puget Sound Energy 805 156t Avenue NE Bellevue,WA 98004 888-225-5773 4. Telephone: Qwest Communications 801-962-2475(phone)/801-237-6491 (fax) 5. Water: Lakehaven Utility District Tacoma Public Utilities Technical Service Division Customer Service 31623 First Avenue South —OR— 747 Market Street Federal Way,WA 98003 Tacoma,WA 98402 253-941-2288 253-383-9600 or 253-383-2471 6. Garbage: Waste Management 655 Second NW Auburn,WA 98071 253-833-3333(residential)—OR—253-939-9792(commercial) 7. Sewer: Lakehaven Utility District Technical Services Division 31623 First Avenue South Federal Way,WA 98003 253-941-2288 8. Septic: King County Environmental Services 14350 SE Eastgate Way Bellevue,WA 98007 206-296-4932 9. Fire Department: South King Fire&Rescue 33325 8th Avenue South/PO Box 9718 Federal Way,WA 98063 • 253-946-7248 Bulletin#109—March 1,2007 Page 1 of 1 k:\Handouts\Demolition Permit Contact List • AMB We Do Abatement dba K&T We Do Dirt P.O. Box 3123 Arlington, WA 98223 360-657-0390 Office 360-657-0391 Fax Contractor's License #KTWEDTW917PA Asbestos Contractor Certification # 1522 CERTIFICATE OF COMPLETION For Asbestos Project 8/12/2013 On 8/10/2013 asbestos abatement services were completed at: 28722 Pacific Hwy S. Federal Way, WA 98003 AMB We Do Abatement job# 2011340 Be assured that all activities as set forth in our proposals of 6/21/2013 &8/8/2013 were completed, and were conducted in accordance with all currently applicable regional, state, and federal environmental regulations. Air monitoring required by regulation was performed. Clearance air sampling verified that the air was clean by current regional, state, and national standards. Regulated waste was deposited in an approved facility. Asbestos liability insurance and a contractor's surety bond were in effect during our operations. Please feel free to contact us at (360) 657-0390 between 8:00am and 5:00pm Monday through Friday if you have any further questions or need additional documentation. Approved Transaction • Page 1 of 1 pscleanair.org Puget Sound Agency Notification Case #: 201302635 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # VREF9I3C4E403 Transaction Date 07/25/13 Owner's Name Poll Federal Way LLC Phone (206) 335-7168 Project Street Address 28722 Pacific Ave.S. City Federal Way Zip 98003 Contact Person Todd Sandal Phone (206) 335-7168 Mailing Address 8915 SE 44th St. Mercer Island, WA 98040 This project includes a demolition. Demolition Start Date 08/12/13 Completion Date 10/31/13 Demolition will be completed by a demolition contractor Demo Contractor Wilcox Construction Contractor Job Contact Paul Carter Phone (425) 774-41.E Mailing Address 234 5th Ave. S. Edmonds,WA 98020 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Cre.tø. - * * View History Lag„Slul If you have questions, contact us at asbestos@pscleanairorg or 206.689.4058. https://secure.pscleanair.orglAsbestos/Approved.aspx 7125f2013