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23-102987City of Federal Way Community Development Dept. 33325 8th Ave S Federal Way, WA 98003 Ph: (253) 835-2607 Fax: (253) 835-2609 Project Name: PELKEY Project Address: 30601 1ST PL SW Project Description: Demolition of fire -damaged single family residence. Demolition Permit #:23-102987-00-DE Inspection Request Line: (253) 835-3050 Parcel Number: 556000 0920 Owner Applicant Contractor C E PELKEY HEATHER BROTHERSRIVERS EDGE RIVERS EDGE ENVIRONMENTAL 30601 1ST PL SW ENVIRONMENTAL SERVICES INC SERVICES INC FEDERAL WAY WA 98023 17115 SE 270TH PL SUITE 106 RIVEREE855DT (3/30/25) COVINGTON WA 98042 17115 SE 270TH PL SUITE 106 COVINGTON WA 98042 Additional Permit Information CONDITIONS: Prior to final inspection approval from King County Health is required for abandoned septic system. PERMIT EXPIRES Monday, 4 December, 2023 Permit Issued on Wednesday, June 7, 2023 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. Owner or agent: 1" Date: THIS CARD IS TO REMAIN ON -SITE CITY OF �� Construction Inspection Record Federal Way INSPECTION REQUESTS: (253) 835-3050 PERMIT #: 23 102987 00 Address: 30601 1ST PL SW Project: C E PELKEY FEDERAL WAY WA 98023-3902 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. Ell Final - Building (4050) A Approved Date �rlgLl?, ok-111 5� ❑ Rough Electrical Final Electrical Right of Way Approved Approved Approved By Date By Date Bv Date A CITY OF Federal Way RECEIVED �)1� JUN 0 7 2023 PERMIT APPLICATION CITY OF FEDEFIAt T CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 eorMl�llluNmr A�1+l=LOPM r 835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com PERMIT NUMBER _a : _ 1 —0 —a C.J 1 — / ` JE TARGET DA SITE ADDRESS SUITE/UNIT n 30601 1st Place SW, Federal Way, WA 98023 PROJECT VALUATION ZONING ASSESSOR'S TAX(PARCEL # $ 4,400.00 _5_ _5 - 6 0 Q Q- Q 2 2 -0 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ® DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT City of Federal Way - Pelkey Demo Demolition of existing structures and debris from site. PROJECT DESCRIPTION Detailed description of work to be included on this permit only NAME PRIMARY PHONE City of Federal Way 253-835-2648 MAILING ADDRESS E-MAIL PROPERTY OWNER 33325 8th Ave South christina.dunlap@cityoffederalway.com CITY STATE ZIP Federal Wa WA 99003 ,p "ry NAME Rivers Edge Environmental Services, Inc. PHONE 425-584-7089 MAILING ADDRESS E-MAIL ID 17115 SE 270th Place Suite 106 rojects rivers.ci CONTRACTOR CITY STATE ZIP FAX Covington WA 98042 WA STATE CONTRACTOR'S LICENSE # RIVEREE855DT EXPIRATION DATE 03 / 30 / 2025 UBI # 603 483 511 NAME Heather Brothers PRIMARY PHONE 425-584-7089 0 APPLICANT MAILING ADDRESS 17115 SE 270th Place, Suite 106 E-MAIL projects city CITY STATE ZIP FAX Covington WA 98042 NAME PRIMARY PHONE PROJECT CONTACT Heather Brothers 425-584-7089 MAILING ADDRESS 17115 SE 270th Place, Suite 106 E-MAIL projects@rivers.city (The individual to receive and respond to all correspondence CITY STATE ZIP Covington WA 98042 FAX concerning this application) PROJECT FINANCING NAME ® OWNER -FINANCED When value is $5,000 or more MAILING ADDRESS, CITY, STATE, ZIP PHONE (RCW 19.27.095) 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 authorised 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 casts, expenses, and attarneys' 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 arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as apart of this application. SIGNATURE: DATE 05/23/2023 PRINT NAME: HQather Brothers Bulletin #100 — February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application VA MECHANICAL PERMIT LUE OF MECHANICAL WORK Indicate how many o each type of Lrture to be installed or relocated as part of this project. Do not include existing fixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS (comm_i.1) BOILERS FURNACES HOT WATER TANKS (Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES PLUMBING PERMIT Indicate how many of each type a inure to be installed or relocated as part of this project. Do not include existinigfLxtures to remain. BATHTUBS (or Tub/SbowerComb,) LAVS (Hand Si k,) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS (K,mbeo/Uca1ry) WATER HEATERS (Eieec;e) HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? C Yes D No ❑ Yes :i No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT FIRST FLOOR (or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER (describe) Area Totals EXISTING PROPOSED TOTAL **NEW HOMES ONLY** ESTIMATED SELLING PRICE $ # OF BEDROOMS COMMERCIAL — NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information NEW BmLDING ADDITION COMMERCIAL — REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin #100 — February 19, 2020 Page 2 of k:\Handouts\Permit Application CITY OF ---_ - Federal Way COMMUNITY DEVELOPMENT DEPARTMENT 33325 8'1' Avenue South Federal Way, WA 98003 253-835-2607;Fax 253-835-2609 wv, Nv. ci rvo tTedera I way.com DEMOLITION PERMIT REQUIREMENTS A demolition pen -nit is required to remove any structure on a subject property. Demolition of separate structures may require separate permits. ❑ Address of Demolition: 30601 15t Place SW, Federal Way, WA 98023 ❑ Prior to submitting a demolition permit, the following items must be signed by the respective agency or their approvals attached. Items not applicable to your project should be marked N/A. ❑ A completed Construction Permit Application form is also required. 1. ASBESTOS ABATEMENT (Provide copy of Notice of Intentfrom Puget Sound Clean Air Agency and c of inspectionreport.by AFIERA-certified inspector) (City of Federal Way SuildiPg Official) 2. FUEL STORAGE TANKS V ❑ Under grade tank(s) is/are present • Above grade tank(s) are present ❑ Tank(s) has been pumped or removed under South King Fire & Rescue permit prior to any dismantling or excavation A (South King Fire and Rescue) 3. SEPTIC SYSTEM DECOMISSIONING Jy ! (ling County Environmental Sery es) *Septic to be decommissioned after mobilization to site to demolish house when contractor will be on site. 4. SANITARY SEWER NA (Lakehaven Water & Sewer District) & ELECTRICITY N/A — Power to Remain, Owner to reconnect to new home (Puget Sound EnergyjTacoma Power) 6. NATURAL GAS N/APc��c�� t 3 z 3 0) r- P h (Puget Sound Energy) �3 _ r O' 5 V 7. WATER - Public Source N/A Water to Remain (Lakehaven water & Sewer district) 8. WATER - Private Well N/A (King County Environmental Services) ❑ Please Note: Erosion control measures must be in place during the demolition and through completion of the site clean-up. Bulletin #122 — April 8, 2021 Page 1 of 1 k:\Handouts\Demolition Permit Requirements COMMUNITY DEVELOPMENT DEPARTMENT 33325 811 Avenue South Federal Way, WA 98003 CITY OF = 253-835-2607; Fax 253-835-2609 .v.v.v,cit tifederal.va .s:om Federal Way DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure on a subject.property. Demolition of separate structures may require separate permits. ❑ Address of Demolition: 38681 1" Place SW Federal Way, WA 98023 ❑ Prior to submitting a demolition permit, the following items must be signed by the respective agency or their approvals attached. Items not applicable to your project should be marked N/A. ❑ A completed Construction Permit Application form is also required. 1. ASBESTOS ABATEMENT (Provide copy of Notice oflntentfrom Puget Sound Clean Air Agency and copy of inspection report by AHERA-certified inspector) (City of Federal Way Building Official) 2. FUEL STORAGE TANKS ❑ Under grade tank(s) is/are present ❑ Above grade tank(s) are present ❑ Tank(s) has been pumped or removed under South King Fire & Rescue permit prior to any dismantling or excavation N/A (South King Fire and Rescue) 3. SEPTIC SYSTEM DECOMISSIONING (King County Environmental Services) *Septic to be decommissioned after mobilization to site to demolish house when contractor will be on site. 4. SANITARY SEWER N/A (l.akehaven Water & Sewer District) S. ELECTRICITY N/A — Power to Remain, Owner to reconnect to new home (Puget Sound Energy/Tacoma Power) 6. NATURAL GAS N/A (Puget Sound Energy) 7. WATER - Public Source Water meter to remain and be protected during construction. (Lakehaven Water & Sewer District) sly; aw' S. WATER - Private Well N/A (King County Environmental Services) ❑ Please Note: Erosion control measures must be in place during the demolition and through completion of the site clean-up. i tt6A,d- (Applicant) Bulletin #122 — April 8, 2021 Page 1 of i k:\Handouts\Demolition Permit Requirements CAJ 1'' PU6¢TSOUND Clean Air Agency Singlie-Family Notification Case #: 202302297 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 # AEOA5B7C3D62 Transaction Date 05/24/23 owner's Name City of Federal Way Project Street Address 30601 1st Place, SW City Federal Way Contact Person Christina Dunlap Mailing Address 33325 8th Ave S Federal Way, WA 98003 This project includes a demolition. Demolition Start Date 06/03/23 Completion Date 12/30/23 Demolition will be completed by a demolition contractor Phone (253) 835-2648 Zip 98023 Phone (253) 835-2648 I certify that: (1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile. (2) The information I have provided is to the best of my knowledge accurate and complete. (3) I understand the fee for this Notification is nonrefundable. Create Another Notification If you have questions, contact us at asbestos@pscleanair.gov or 206.689.4058. ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWEST �"' 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 Asbestos Northwest, LLC - Survey Report 30620 Pacific Hwy S, #103, Federal Way, WA 98003 253.941.4343 Survey Location: 30601 1st PI SW Federal Way WA Prepared for: City of Federal Way Code Enforcement Date: March 22"d 2023 Asbestos Northwest Batch Number: 202311066 Inspector: Sean Butler (#18-5050) E-mail: seanb[c]asbestosnw.com 1 ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWESTAA" 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 Contents 1. Background Information and Scope of Work............................................................................3 2. Main Building Description ................................ StructuralSystem.....................................................................................................................................4 FinishingMaterials ..............................................................................................................................4 Mechanicalsystem...................................................................................................................................4 Electricalsystem ............... :............................................ ........... 4 Insulation..................................................................................................................................................... 4 Roofing... ................. ........... . ............................................................................................................... — A 3. Material Sampling Information ................................................. ................................................. 5 Definitions............................................................................................................_................................. 5 SurveyMethodology.......................................................................--•--•-----....._........................................ 5 4. Asbestos Containing Material..................................................................................................7 5. Conclusions.............................................................................................................................8 AppendixA — Certifications.............................................................................................................9 AppendixB — Building Layout.......................................................................................................11 LivingRoom ........................................ .................. ......................... ........................ ................. .....12 Kitchen..................................................................................•..-----................................................12 BackCorner Bedroom...................................................................................................................13 FrontMiddle Bedroom........................•----.................,........................................................-•-•- ...--.13 Appendix C — Laboratory Report...................................................................................................14 2 . ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWESTA" 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 941417S 1. Background Information and Scope of Work On March 22"d 2023 Asbestos Northwest, LLC conducted an AHERA survey of the single- family residence located at 30601 1It PI SW in Federal Way WA. AHERA-certified building inspector Sean Butler (#18-5050) conducted the survey to determine the presence of Asbestos Containing Materials (ACM's) prior to the demolition of the building after damage from a fire. The home had contained a large amount of personal property and most of this was still in place, somewhat restricting access to the bathroom and one of the bedrooms. The fire appeared to have started in the living room and kitchen area resulting in extensive damage to this portion of the building. Smoke damage was present throughout the rest of the interior, and utilities had been disconnected. The home had three bedrooms and a single bathroom all located at one end of the building, with common areas located on the other side.. The overall layout of the building appeared to be conventional and largely unaltered. A carport was in place under the same roofline of the home, but there was no garage and no significant outbuildings on the property. The home had undergone some alterations during its life, largely limited to changes in flooring materials. There was no clear distinction between different eras of work or types of materials in use. For the purposes of this inspection the building was considered to be a single homogenous area. Samples were taken from the interior and exterior of the buildings. All areas of the building were accessible to the inspector with the exception of the garage conversion. See the attached layout drawing with sample locations in Appendix B. Materials were located and sampled following AHERA protocol in 40 CFR 763.86, then analyzed in-house at Asbestos Northwest per 40 CFR 763.86. See section 3 for detailed sampling information. 3 ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS ► S B r C T O C NORTHWEST�" 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 2. Main Building Description County records indicate that the building was originally constructed in 1961 and had a total finished area of roughly 800ft2 over a single floor. It had three bedrooms and a single bathroom in a conventional layout, with a carport adjacent to the living room. It had suffered extensive damage from a fire, and appeared to have been unmaintained prior to the fire. The building will be demolished. Structural System The building was of wood -framed construction, on a concrete foundation with a crawl space below. The overall structure was likely unaltered from new. Finishing Materials The interior walls and most ceilings were finished drywall, which had been burned away in the living room and kitchen area. The home lacked popcorn ceilings and other heavy texture materials. Flooring appeared to have been mostly a mix of carpet and wood laminate, with vinyl in the bathroom and kitchen areas. Mechanical system The home had a forced air heating system with the furnace located in a hall closet and air supplied through metal ducting run below the floors. No suspect wrap or tape materials were encountered. A stove was stove was also located in the living room. Electrical system The electrical system was disabled at the time of the inspection. Visible wiring was rubber insulated. The electrical panel contained breakers and had no suspect backing materials visible. Insulation The home had wood fiber insulation in place. No vermiculite or other suspect insulation materials were encountered during the inspection process. Roofing The home had an asphalt shingle roof with a tar paper vapor barrier. ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWEST �" 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 2S3 9414343 Fax: 2S3 941417S 3. Material Sampling Information Asbestos survey work performed by Asbestos Northwest meets inspection regulatory requirements enforced by federal, state, and local agencies, including Asbestos Hazard Emergency Response Act (AHERA), WAC 296-62-077 (WISHA) and 40 CFR Part 61 (NESHAP) and 29 CFR Part 1926.1101 (OSHA) Definitions Homogenous — Materials with the same appearance, texture, color, and which were applied during the same general construction period. Surfacing Material — Material that has been sprayed -on, troweled -on or otherwise applied to surfaces, such as acoustical plaster, texture and joint compound, and fireproofing materials on structural members. Thermal System Insulation — Material applied to pipes, fittings, boilers, breaching, ducts, and other interior structural components to prevent heat loss or gain. Miscellaneous Material — Building materials such as structural components, structural members or fixtures not included in surfacing and thermal insulation. Survey Methodology Before sampling began, inspectors documented the total surveyed area. A sketch of each space was created, and total square footage was roughly measured. The inspectors then determined the extent of each visible homogenous material throughout the survey area. Materials were classified as surfacing, thermal insulation, or miscellaneous material, and friability was assessed according to AHERA specifications. Materials were sampled according to 40 CFR 763.86. Depending on homogeneity, square footage, and material type, the proper number of samples needed to accurately assess the location and extent of asbestos was determined and collected. At the point of collection, samples were placed in an appropriate container and labeled. Location was noted on the building floor plan, and a description of the material was recorded with the label number. Sampling tools were then wiped clean to prevent contamination between samples. Any suspect debris was sealed. The samples were then counted, and their label numbers were recorded on a chain of custody form. The inspector then signed and released the form to' the laboratory with the samples. Samples were analyzed in-house at Asbestos Northwest. Below is a list of all materials sampled. Appendix C contains the laboratory report and analytical results for each sample. ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 941417S Description Material Type Sample Numbers and Locations 1- Back Corner Bedroom Wall Joint Compound Friable Surfacing 3- Front Corner Bedroom Wall Asbestos Containing Material 5- Bathroom Wall 8- Living Room Wall Texture Friable Surfacing 2- Back Corner Bedroom Wall Asbestos Containing Material 4- Front Corner Bedroom Wall6- Bathroom Wall White Sheet Vinyl Non -Friable 7- Bathroom Floor Miscellaneous Material Texture Friable Surfacing Material 1 I 9- Living Room Wall III White Vinyl Tile and Mastic Non -Friable 10- Kitchen Floor Miscellaneous Material Asphaltic Shingle and Tar Non -Friable Paper Miscellaneous Material 11- Roof Tar Paper Non -Friable 12- Under Siding Miscellaneous Material Brown Fibrous Insulation Friable Miscellaneous 13- Attic Material • ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 4. Asbestos Containing Material A homogenous material is considered ACM (Asbestos Containing Material) if one or more samples of the material are found to have greater than 1 % asbestos. Analysis can result in both positive and negative conclusions in materials containing less than 10% asbestos, or materials that have very fine asbestos fibers, have been hand mixed, or have asbestos fibers tightly bound in the matrix; therefore, EPA recommends a minimum of three samples be analyzed by PLM for these types of materials. All materials that were sampled during the inspection were analyzed under PLM, EPA Method 600/R-93/116. Laboratory results show that seven of the samples taken contained asbestos. Description and Asbestos Material Type and Estimated Type I Quantity Locations 1- Back Corner Bedroom Wall Joint Compound Friable Surfacing Material 3- Front Corner Bedroom Wall 2% Chrysotile See Conclusions 5- Bathroom Wall Asbestos 8- Living Room Wall Texture Friable Surfacing Material 2- Back Corner Bedroom Wall 2% Chrysotile See Conclusions 4- Front Corner Bedroom Wall Asbestos 6- Bathroom Wall 7 ASBESTOS NORTHWEST LLC SURVEY REPORT 5. Conclusions ASBESTOS t NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 All four samples of joint compound taken from within the home were found to contain asbestos. These samples came from throughout the home. All joint compound within the home should be treated as asbestos containing. Four of the five samples of texture taken from within the home were found to contain asbestos. These samples came from throughout the home. One sample of texture was asbestos free, this came from the living room area which was badly damaged by the fire. All texture within the home should be treated as asbestos containing. None of the other materials sampled during the inspection process were found to contain asbestos. Materials in use within the building were generally simple and were consistent with a residential structure. The home lacked some of the materials seen in older homes, such as suspect window glazing putty materials, or suspect insulation products. Fire damage and personal property within the building did somewhat limit access to the interior. Further materials may be identified during the demolition process that would warrant testing. Any identified asbestos containing material must be abated before demolition can continue. A Certified Asbestos Abatement Contractor must carry out abatement. Different materials require different abatement processes depending on the friability, type of asbestos, and amount of asbestos present. It is important that materials are treated by a Certified Asbestos Abatement Contractor. 8 • ASBESTOS NORTHWEST LLC SURVEY REPORT Appendix A — Certifications E ASBESTOS NORTHWEST �i" 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 2S3 9414175 ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 941417S 21905 64th Ave W, #100 y Moun0ake Terrace. WA 98043 (206) 285-3373 7 _ �� This certifies that lAA1N1NG•7N511.RNGn Sean T. Butler has satisfactorily completed 4 hours of online refresher training as an AHERA Building Inspector to comply with the training requirements of TSCA Title II, 40 CFR 763 (AHERA) r/r/f�. •' EPA Provider # 1085 Instructor:Sue Maas Date: May 11.2022 Expires In 1 year Cart. Num: 185050 its] ASBESTOS NORTHWEST LLC SURVEY REPORT Appendix B — Building Layout •to ■7 ---T 1#3 ASBESTOSOf NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 4 i � 1.--3 ,w�e�5 �" \Z to CA'4^ • 0-3%De S�05 e� t I t. C v 11 ASBESTOS NORTHWEST LLC SURVEY REPORT L. 1�ccm Kitchen 12 ASBESTOS NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 ' ASBESTOS NORTHWEST LLC SURVEY REPORT Back Corner Bedroom Front Middle Bedroom 13 ASBESTOS NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 2S3 941417S ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS "` NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 Appendix C — Laboratory Report NORTBHWE�STA4d" Asbestos NW Batch# 202311066 30620 Pacific Hwy S. #103, Federal Way, WA 98003 (253) 941-4343 NVLAP Lab Code: 200993-0 Bulk Samples Chain of Custody (EPA 600/R-93/116) Name/Company City of Federal Way Code Enforcement Date 3/22/2023 Address, 33325 8th Ave S Federal Way WA 98023 Phone. 253 835 2617 E-mail: Christina.Duntai2@cityoffederalway.c_._in F; ojcct Manager Christina Dunlap Project Location: 30601 1st PI SW Federal Way WA 98023 Number of Samples. 13 Turn around hme 7') # Sample ID Description Location/Comments 1 1 Joint Compound Back Corner Bedroom Wall 2 3 4 5 2 3 4 5 Texture Joint Com ❑und Texture Joint Compound Back Corner Bedroom Wall Front Corner Bedroom Wall Front Corner Bedroom Wall Bathroom Wall 6 6 Texture Bathroom Wall 7 7 White Sheet Vinyl Bathroom Floor 8 9 8 9 Joint Compound Texture Living Room Wall Living Room Wall 10 10 White Vinyl Tile Kitchen Floor 11 11 Asphaltic Shingle and Tar Paper Roof 12 12 i ar Paper Under Siding 13 13 Brown Fibrous Insulation Attic 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Print Stan Comoanv nntp Timp Sampled by: Sean Butler u _ Asbestos Northwest 3/22/2023 1:OOPM Relinquished by: Delivered by: Sean Butler Asbestos Northwest 3/22/2023 2:OOPM Accepted by: Dan Lafley Asbestos Northwest 3/22/2023 2:OOPM Analyzed by jjq, Asbestos Northwest 1' 14 ' ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWEST �i" 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 NORTHWEOSTi \,lentos \,,rthltr�l. LI-C 'E'r"'� 4 nvt.�e , ai�rosu titiwr . 0620 Pacilic I I++N S. "I034. Federal \\ a.N, OVA 98001" 1111: (2; ") 1) 1 1--I ,4 3 Batch Number: 202311066 PLNI Analysis by Ell A Method 600/,N]4-82-020 and 600/R-93/116 Ti,r, repoil mlsl not be used by 01• Cheri to da:m product certification, approval, nr endorsement by NVI 1P, NIST, pr anv agenry of the L1,S, Governrn.^nt Attn: Christina Dunlap Cif• of Federal Way Code Enforcement 33325 8th Ave S Federal Way WA 98023 Location: 30601 Ist PI SW Federal Way WA 98023 Date Received: 3/22/2023 Date Analyzed: 3/23/2022 Samples Received: 13 Samples Analyzed: 13 ('licnl S:nnple Lab Sample %, Non -Asbestos %, Asbestos Fibers Laver Description Matrix II) ID Fibers anll'I}pc Fain po++der\ nlateiial ++ilh Billdcr'liller- I I U" n Cellulose 2"lit Chrvsotile charred paint and paper Paint White chalky material with Fillerrbinder, 25°•6 Cellulose, — ? None Detected paper Gypsum Glass libers fan po++dei\ material ++ith l.iinderliller• _ I Cclluloic 2r h Chr�'solilc -- Charred painl faint White chalk\ material ++ill) I illtrr. hirtutt:r. => -'o Cellulu,r. None Detected paper lt+p'lrin Glass libers Tall po\+der\ material ill) Binder.!filler, I IOo i, Cellulose 2 / Chnsolile paint and paper Paint 254•o Cellulose. White chalky material ++nth Filler: hinder. ` paper G+Psunl Glans libers None Detected WIIIYe chalky material Rith Filler/blllder. 2J°n CCIIUIuie. I None Delectell paint and paper G\Psunl, Paint Glass fiber, Fan po++den material ++ith l3inder"hiler, > 1 p 10.'b CclIll lose 2'1r Chr-vsotilc Paull and paper Paint While chalk• material ++ith Filler,/binder, 25'o Cellulose. None Detected paper G',psuIll Glass fibers fan powdery material mth Bindedliller. 6 1 10"ro C'elluloic 2 % Chrvsotile paim and paper Paint \\ hlte chalk\ material mill F iller'•'hinder, 259'n CClllllose, - None DCleCrl'll paper G\Pill ill Glass fibers 1 Gravrr!rcen sheet vinvl V'invlihinder None Detected None Detected Black fibrous material w ith 1 illcr. 7s`!11 Cellulose. None Detected mastic Mastic/hilider Svnthctic libers Analyzed by: Cathy Butler,. ' Report Page I 15 ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS NORTHWEST 30620 Pacific Hwy S Suite 103 Federal Way, WA 98003 Tel: 253 9414343 Fax: 253 9414175 ASBESTOSr-_ NORTHWEST EST � ��f � ��,� Asbestos Northwest. LLC' TEST IN MLAP LAD IOOC 7 -v..! 30620 Pacific 11%v\ 5, 9103, Federal Wad.'1VA 98003 I'll: (253) 941- 3a3 Batch Number: 202311066 PLM Analysis by EPA Method 600/M4-82-020 and 600/R-93/116 This report must not be used by the client to clam product certification, approval, or endorsement by NVLAP, N!5T, or any agency of the U 5 Government Attn: Christina Dunlap - Cihv of Federal Way Code Enforcement 33325 8th A-vc S federal Wav WA 98023 Location: 30601 lst PI SW Federal -Way WA 98023 Date Recek,ed: 3/22/2023 Date Analyzed: 3/23/2022 Samples Received: 13 Samples Analized: 13 C licnt Sample tsb Sample Layer Description Matrix % Non -Asbestos % Asbestos Fibers 1D !!) Fibers and Typc Fall Po\%Clcn nuttelial %lilh BindeNliller, charred Paint and chr!rred Paper Paint 10"„ Cellulose 2'%, Chnsotilc `l I White chalk% material t%ith Filler/binder, 250/, Cellulose, charred paint and paper Q psunt, Paint Glass fibers None Detected 10 1 Off kkilite tilt Viml!hinLler. 11:0 Cellulose None Detected Mineral ,rains 2 YellO\1 mastic Mastic/hinder 2% Cellulose None Detected Black asphaltic material with Asphalt'binder. 'f L. I I 1 sand Sand Glass fibers. vote Detected _r ` _ _,I?r,h.•LL�sJ.�.,.- Black asphaltic fibrous 30"„ Cellulose. .. material Asphalt/binderNone Glass Fibers Detected Black asphaltic fibrous 80% Cellulose, I material Asphalt/binder Glass Fibers None Detected I3 Bruhn fibrous material Wood None Detected None Detected Ag11 gregates Analyzed by: Cathy Butlerf ` t/ ! A•/ ,r. Itvpprt Page 2 - 16