05-106206 . T - . R
ilk City of Federal Way 1 Demolition Permit #: 05-106206-00-DE
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: O'BRIEN/MOUNTS
Project Address: 801 SW 356TH ST Parcel Number: 440560 0190
Project Description: Demolish portion of existing residence and detached garage.
Owner Applicant Contractor
LEIGHTON O'BRIEN LEIGHTON O'BRIEN LEIGHTON O'BRIEN
1433 SW 344TH PL 1433 SW 344TH PL 1433 SW 344TH PL
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit Information
CONDITIONS:
PERMIT EXPIRES Thursday, December 6, 2007
Permit Issued on Tuesday, December 6, 2005
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
° 12 �/a
Owner or agent: (� - Date: /Q S
° THIS CARD IS TO AIN ON-SITE .
CITY OF Pommunity Devilo me t Inspection Record,
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-106206-00-DE
Owner: LEIGHTON O'BRIEN
Address: 801 SW 356TH ST
FEDERAL WAY, WA 98023-7202
This card is part of your required inspection documents. 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.
❑ Final-Building(4050)
Approved
By Date 71/04,,
• a3 - /0 ( aa� - 00
1 RECORDING NO.: VOL./GE:'
CITY OF FEDERAL WAY S�3OR T PLAT
FOR LEIGHTON O'BRIEN SCALE: GRAPHIC SCALE 1~=30'
liMinlii!LOCATED IN THE S.E. 1/4, OF THE N.W. 1/4, 1 inch - 30 FT, 30 0 30
OP SECTION 30, TOWNSHIP 21 NORTH, RANGE 4 EAST, W.H., PORTION OF:
KING COUNTY, WASHINGTON S.E. 1/4, N.W. 1/4, SEC. 30. T.21 NORTH, R.4 EAST. W.M.
WAY
SHINGTON
\ //4- o1/4.,
sU BASIS OF REARMS:
MN IP 347.53
cm cE1 . 32t 24CENTERLIBE OF SOUTH 360TH snare- BEING
SOUTH Brspor WEST AS SHOWN ON THE PLAT
\ ` BEARINGS SHOO HEREON ARE BASED ON THE
� Of t'a GAN WNOR. RECORDED IN Vb1.l1ME4s
�, \� * OF PLATS, AT PAGES 33-34. RECORDS OF KING
COUNTY. 164SHINOTO�1.
r As DESCRIBED '' , ' REFERENCE SURVEYS:
MANHOLE 4 7. /\ rt•ro186 yh `�' =a 40.
,� �,• �' TAT: L'oew�w wwDR, MIME PAGES 33-3.
ROS 1: REC Na 2041062$900010) VOLUME 145 PAGES 294-2849
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• PARENT PARCEL:
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' I 1 BENCHMARK:
1.07 3
CITY OF FEDERAL
LSDI , -37
SOUTH CORNER VAULT 'Y BENCHMARK216N Of
SOUTH 356TH STREET ON 4TH AVENUE SOUTHWEST
g R ELEVATION ir 304.21 U.S. FEET.
1144.014 . 1 ku SITE BENCHMARK:
ri 5Ti
�ALRESU lTTE •Federalway PERMIT 5 - „-
F oDxanlHrtrDEVELOPMENT sElQvlcEs DEC 0 0 20 5 SF MF CO ME EL PL N FP
3.2325 8TM AVENUE spurn•PO BOX 9718 p
PEDERALWAY,WA 9806J-/ZIN OF.FED& L�bj/ CATION
253 83....PAX 253d35-26Dl� , i t- I
iirlim. ..1 .1 jr ma
wuw.al�med4.anauyc�m BUILDING DEPT.
The oilowt • is re•uired in ormation-an inco ,lete a,,lication will not be acce•ted. Please ,rint le• •t in i or ,e.
MIPROPERTY INFORMATION
...imp SITE ADDRESS 'O[/ Sc/ -- S6 t'1 -7 - sr,c 2-,L 4-'/ �'1 Z.,
' 7 SUITE/UNIT i
_ —•
ASSESSOR'S TAX/PARCEL# - _ _ LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Aaadh aeparatepage fir lergIJW Mgd deso4Nm)
^
• PROJECT INFORMATION
TYPE OF PERMIT UILDING ❑ PLUMBING 0 MECHANICAL
EMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
I,Cka _ �t eta wei" 7 ,, ,..,�5'�u 4CQ
L� Z,ZI /! �' c< <- elf
5tA;Ay 1 A�2��pr •
PROJECT NAME(Name of Business or Owner Last Name) 66(I 6i1 5 41'0
• • PEOPLE INFORMATION
PROPERTY NAME
i1�Uc dA,644„,-131PRIMARY PHONE
OWNER 'lCffrvrl/ U�ct�'ii � 4a I ( ASS) 13 z- lLv l
MAILING ADDRESS CITY,STATE,ZIP
S LLf er(L f0_.„,` Cc"yLCc) GSZ_5
CONTRACTOR COMPANY NAMES,,/� APPLICANT NAME OFFICE PHONE
( 4/'te ( -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
•
CITY OF'FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
a - — / / ( )
CONTRACTORS REGISTRATION NUMBER(copy of cud required with each application) EXPIRATION DATE
.• / /
APPLICANT COMPANY E APPLICANT NAME OFFICE PHONE
,7,4-�c 4 S Lail ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT ( )
FAX NUMBER
a Architect a Tenant a Agent a Other(Describe) ( ) _
CONTACT NAME � ��v PRIMARY PHONE
7 E-MAIL ADDRESS
l t ,\ (753 ) 1 - /6c1
LENDER ;a.,; arm?-1 r 14,( f,071pia r17 s NAME
MAILING ADDRESS CITY,STATE,ZIP
• ■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES a NO
WATER SERVICE PROVIDER a LAKEHAVEN ❑HIGHLINE ❑TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
4
FOURTH •
ADDITIONAL FLOORS(DESC •
DECK(COVERED?)
GARAGE 0 CARPORT 0
11OUSTO10 ! -• TOTAL �°a ,ion ✓ It - `l a 6!
NUMBER OF FLOORS " _
C
"NEW HOMES ONLY'* NUMBER OF BEDROOMS ESTIMATED ' NG PRICE $
I.'TURES
Indicate number of each type of fixture to be installed or relocat -t` part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
•
AIR HANDLING UNITS EVAPO: VE COOLERS • LOGS REFRIG.SYSTEMS
BBQS F H••• ' conssoKtoq WOODSTOVES
BOILERS 4 PLACE INSERTS RANG MISC(Describe)
COMPRESSORS RNACES OAS WATE' TERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/shower •• SHOWERS WATER CLOSETS(use) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTL SUMPS RAINWATER SYST
WASHING M ' NES URINALS HOSE BIBBS
LAVS stow VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,but only where such claim
arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information supplied to the city as°a part of
this application. r
NAME/TITLE DATE , t 12-4(05—
(S ature) C641.--..." (Title)
RELATIONSHIP O ❑ Owner ❑Agent ❑ Contractor 0 Architect 0 Other
.ILJ' l c `l �t ��4 +�i.(C) E � ;a te �I .('�;r�t �ukleAa"JMID401''
estt�e�e�te� 3 t5ct,c e)�L6'eV ys 1M-) ;_y�}lt w,�� � y,� l01
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e,
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Pernut Application
j JP
• AIL
v DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 86 Avenue South
CITY OFrM+'�
PO Box 9718
Federal WayRESUBMITTED Federal Way WA 98063-9718
253-835-2607;Fax 253-835-2609
www.cityoffederalway.com
DEC 0 6 2005
DEMOLITION PEtiaitialifr :� ;REMENTS
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.
❑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.AS E OS 1.ATEMENT 6. ELECTRICITY
(Copy(A pproval jinn and asbestos survey from Puget Sound Clean Air (Electridty to bed off and meter removed) y�—
Agency ro ' ed)I ,N/ ft . '0 - �.B'Yt...10 UCH. -v
1 (Puget Sound Energy) r
1(City of ederal Way Building Official)
2. GAS SUPPLY 7. FUEL STORAGE TANKS
(Gas to be shut off,meth moved and final bill paid) (Above or below grade fuel tanks, have been pumped or removed
/�/ under Fire Depart nyn permit prior to any dismantle/excavation)
Puget Sound Energy)
Federal Way Fire District#39)
3.S STEM 8.WATER- Public Source (Check applicable box)
rank to be remo k to be drained and filled) o Meter to be removed and final utility bill paid
deter to remain and be protected
0 1 ,ES w 356'J-t,- i` J( _
( Environmental Se 'c ) (Water Supplier LA-e►ea✓
******OR****** ``V
4.SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box)
o Sewer line capped at property line o Private well filled and capped
o Existing sewer line to remain;/i „. used by p posed new structure o Private well to be use for other purposes
( Y 1 r Distil V:i g Codnty Environmental Services)
5.GARBAGE ,
(All household garbage disposed off and final bill paid) A
(RST Disposal/Federal Way Disposal)
0 Completed Construction Permit Application form
0 Provide the following fees: 1.Demolition Permit Fee $63.50
2.Automation Fee 5.00
3.WA State Surcharge 4.50
4. Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspection)
$573.00
•
Bulletin#122-March 9,2005 Page 1 of 1 kAI-Iandouts\Demolition Permit Requirements
DEPARTMENT O_ �JMMUNITY DEVELOPMENT SERVICES
33325 8th Avenue South
PO Box 9718
CITY OF Federal Way WA 98063-9718
Federal Way 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
http://www.pscleanair.org
2. Electricity: Puget Sound Energy
Attn:Construction Coordinator
22828 68th Avenue South,Suite#102
Kent,WA 98032
888-225-5773
3. Gas: Puget Sound Energy
805 156th 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 in r,/,pf
14350 SE East ate Way 0.16
Bellevue,WA 98007 y l q u ` k�
206-296-4932 / ,4,� U I
9. Fire Department: Federal Way Fire Department#39
31617 First Avenue South
Federal Way,WA 98003
253-839-6234
Bulletin#109—October 1,2004 Page 1 of 1 k:\Handouts\Demolition Permit Contact List
Agency Case No. AGENCY,PUGET SOUND CLEAN AI ��
RECEID
200500'838
110 Union Street,Suite 500 D
www.Pi a�'° 38 RESUgN11TTE (�
05
` Agency Use OnlyatilliNgt NOTICE OF INTENT nF C. 0 6 NU)org Agency gT�8 unty
..VINO EA Lpi
A.Project Tyne: 1. U Friable Asbestos Removal 2. ❑ Friable Asbestos Remov ffiiEDE '•'4" Min Only
Property Owner: Le.l(; -(O,t) O,jl+` Phone: 2 S3 7-3 7 ) 6c f
4 �// J r '/
Mailing Address: I4?�3 W 3 L- + L • City: 17EQ,4'L iiJ i State U il'et Zip:f80L3
C. Asbestos PLEASE PRIM'CLEARLY,THIS WILL BE POUR RETURN MAILING LABEL.
Contractor: Owner/CEO:
t. ' ?'1 Contractor
Mailing Address: ' -,Phone: Job No.:
City: State: Zip: -"' ax: ,-y
D. Site ,_ i _�-
Address: 1 5�V 3 S L .5,+ ✓1 ��
_. .._ i. t .,4` A - VO— I Zip:,r,0-�
Site
Manager: Local Phone: 2 S3 '75 Z /6e)/
E. Vi Asbestos Survey or No.of I Date of Asbestos /�h Was Friable Asbestos Identified? UYes tallo
❑ Mat'l Presumed Structures: Survey: �C1' 1/45, Was Nonfriable Asbestos Identified? Yes '�]No
AHERA Building , I- Certification#: 101 Z� �Z Attach a copy of the survey when friable asbestos
' tA,51--RAthUr.,1
has not been identi ed.
Inspector: �1C_XI���� Exp.Date: (1���-. -��^- 0s ,fAn AHERA Survey is required before all demollition project
F. Demolition Start 5 ,� No.of ' 1. LI Training Fire(List Fire Dept.)
Information: Date: 6OV L007 Structures: 2. ❑ Ordered Demolition(attach copy of Order)
Demolition Insert demolition contractor's mailing address on back. Will nonfriable asbestos be left in place during demo? Yes LI No
Contractor: tC L0 41 Y� If yes,list type and qty. Note disposal requirements in tep 6(on back). AC
G. Friable Asbestos Work Days: M T W Th F Sa Su
Project Information: Start Date: Completion Date: Hours:
Will all friable asbestos ❑ Yes
Total Qty.to be Removed: Linear Ft. Square Ft. materials be removed? 'No
LI Boiler\Fumace Insulation LI Duct Insulation U Pipe Insulation LI Fireproofing LI Paints U Plaster LI Textured Coatings
LI Cement Board LI Cement Pipe LI Friable Flooring LI Friable Roofing Material Other:
H. Asbestos/Demolition Project Categories: Notification Period Project Demolition
1. Single-Family Residence(owner-occupied): Fee Surcharge
A. ❑Asbestos Removal Project Only A.Prior Notice A. $25
B. Demolition Project(with or without asbestos removal project) B. 10 Days* CB.'$5 N
*(Asbestos removal can begin upon notification.,demolition must wait 10 days)
Note:If the single family residence is owned by one family who has been or will be using the residence as their domicile, the above boxes
IA or IB may be checked. If this is not an owner-occupied residence,one of the categories listed below must be used instead. A single
family residence does not include rental property,multi family units,or any mixed-use building.
2. G All Other Demolitions(with no Asbestos removal or Nonfriable Asbestos 10 Days $100
only or less than 10 linear feet and/or 48 square feet of friable Asbestos)
Friable Asbestos Projects(other than Single Family Residence): Asbestos Demo
3. Ll _> 10-259 linear feet and/or>_48- 159 square feet of asbestos Prior Notice 10 Days $100 $100
4. LI 260-999 linear feet and/or 160-4,999 square feet of asbestos 10 Days $200 $100
5. LI >I,000linear feet and/or>5,000,square feet of asbestos 10 Days $600 $100
6. LI Emergency Asbestos Project or U Emergency Demolition Project Prior Notice $50 Emergency Fee
(Single-Family Residences are exempt from emergency fee:however,property owner must provide a _ written emergency request)
L I certify that the' ' n contained in
this notification&supplemental data is,to the best of my knowledge.accurate&complete. Age se y
e ae, /
10/1t5A 5— r.
Signature Representing Date Revi ed B(
Puget Sound Clean Air Agency Form No.: 66-160(Revised 2105)TS /,, 42/A5''
The Puget Sound Clean Air Agency r ires advance notification before any pers___ _ommences a friable asbestos project
involving materials equal to or greater in size than 11) linear feet or 48 square feet and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation
III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency
forms. Asbestos removal and demolition projects involving materials and structures below the notification threshold are
still subject to all other requirements of Regulation III,Article 4.
After receiving a complete notification with the appropriate project fee, the Agency will review the form and return a
copy to the asbestos and demolition contractor by mail. The returned copy will be your validated notification.
J. Demolition PLEASE PRINT CLEARLY THIS WILL BE YOUR RETURN MAILING LABEL.
Contractor: Owner/CEO:
Mailing Address: Phone: Contractor's
Job#:
City: State: Zip: Fax:
GUIDELINES FOR SUBMITTING AN ASBESTOSIDEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material,sheet vinyl flooring,cement
asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing
materials.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multi-structure projects, attach supplemental sheet with a site map
(include an address for each site)and a list of the type and amount of friable asbestos to be removed from each structure.
Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency
Response Act(AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the
notification of a demolition project when only nonfriable asbestos or no asbestos is identified on the survey.
Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the
official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire
requirements are contained in Regulation I, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition,
check yes and list the type and quantity of material. Note: Demolition debris containing nonfriable asbestos materials must be
labeled as"nonfriable asbestos-containing waste"and be deposited at an authorized waste disposal facility.
Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as
popcorn ceilings or plaster, sheet vinyl flooring,duct and pipe insulation,cement asbestos board siding or pipe,etc.
Step 8. For owner-occupied Single-Family Residential projects, check BOX H1A for renovation projects or BOX H1B for
demolition projects(with or without asbestos removal). Asbestos removal may be conducted after a complete notification is received,
but demolition activities can only begin on the 10th day after the notification is received. Note:If the single family residence is owned
by one family who has been or will be using the residence as their domicile, boxes 1A or 1B may be checked A single family
residence does not include rental property,multi family units,or any mixed-use building.
For Commercial asbestos projects (or projects that do not qualify as Single Family Residential); check the project category H2 -
5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
(additional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box 1 — 5 and the
applicable emergency box in H6. All emergency requests must be accompanied by a letter from the property owner demonstrating the
need to conduct the project immediately in accordance with the requirements in Regulation III. Section 4.03 (c).
Step 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box I.
Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for
work schedule changes if the contractor is participating in the Agency work schedule fax program. A$25.00 processing fee is required
for all amendments.
Puget Sound Clean Air Agency asbestos regulations and forms can be downloaded from the Agency web page at www.pscleanair.org.
For technical assistance call(206)689-4058 and for administrative inquiries call(206) 689-4090.
Puget Sound Clean Air Agency Form No.: 66-160(Revised 2/05)TS
Certified Asbestos Survey
25744 135th Place S E
Kent,WA 98042
Phone 253 630 3996
October 12,2005
Invoice
#100405
Mr.Layton O'Brien
1433 S W 344t Place
Federal Way,WA 98023
Dear Client,
This invoice is for an asbestos survey completed on October 4,2005
At the home located at 801 S W 356th Street,Federal Way, WA 98023.
25 samples @$10.00 each balance due$250.00
Thank You
Michael Bastanchury
Certified Asbestos Survey
RESUBMITTED
DEC 0 6 2005
CITY OF FEDERAL WAY
BUILDING DEPT.
•
• Certified,Asbestos Survey
25744 135th Place S E
Kent, WA 98042
Phone 253 630 3996
October 12,2005
Mr.Layton O'Brien
1433 S W 344th Place
Federal Way,WA 98023
Dear Client,
On October 4,2005 a survey for asbestos contained in the construction materials that will be disturbed in
the demolition of an addition to the home located at 801 S W 356th Street,Federal Way,WA 98023 was
completed.The owner is Mr.Layton O'Brien phone 253 732 1601 and the addition will be demolished.
Asbestos greater than 1%was detected in sample:
Sample#100405-17,roofing,contained Chrysotile asbestos @ 1.5%PC
Sample#100405-18,roofmg,contained Chrysotile asbestos @ 1.5%PC
The survey was done without limitations.
No hidden or inaccessible areas were found.
All area measurements are approximate.
International Asbestos Testing Labs, 16000 Horizon Way Unite 100,Mt.Laurel,NJ,08054 conducted the
analysis by Polarized Light Microscopy(PLM)and Point Counting(PC).The survey was done by Certified
Asbestos Survey,25744 135th Place S E,Kent,WA 98042 phone 253 630 3996.Michael Bastanchury,
AHERA building inspector certification#1012322 expiring November 3,2005,did the survey in
accordance with sampling protocol outlined in CFR 763.86 by PSAPCA Reg. III Article 4.
Sincerely
Michael Bastanchury
Certified Asbestos Survey
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