Loading...
08-103467City of Federal Way Community Development Services Demolition Perm #. 08- 103467 -00 -DE 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: WA DOT - DEMOLITION Project Address: 933 S 364TH ST Parcel Number: 292104 9110 Project Description: On -site demolition of mobile home & sWe bidldli 99 Owner Applicant Contractor WASHINGTON STATE DEPT OF WASHINGTON STATE DEPT OF WASHINGTON STATE DEPT OF TRANSPORTATION TRANSPORTATION TRANSPORTATION PO BOX 47338 PO BOX 47338 PO BOX 47338 OLYMPIA WA 98504 OLYMPIA WA 98504 OLYMPIA WA 98504 Additional Permit Information CONDITIONS: For relcW of bond, submit re due tq kart ,cii4pier @cityoffederalway.com following final inspection and apPr �_ t_�' S6, THIS CARD IS TO &MAIN ON -SITE • CITY OF Community DevelopniTht Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050 PERMIT #: 08- 103467 -00 -DE Owner: WASHINGTON STATE DEPT OF TRANSPORTATION Address: 933 S 364TH ST FEDERAL WAY, WA 98003 -7437 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. E] Final - Building (4050) Approved By Date N,% a b g For inspector reference only __ ❑ Rough Electrical ❑ FINAL- Electrical Approved Approved By Date By Date My OF 1 FedemivvayRECEI OPERMIT C0MMUNI7YDEVELOPMENT SERVICES 3332S 8m AVENUE FEDERAL WAY,, WA9 063 - 189718 JUL 212AP p LI C ATI O N 2S343S -2607• FAX 2S343S -2609 www.atwfredemlway.com The Gtiowi CITY ;O €i FEERALIIAY f rtg qu r4f n - an mcomplete application will not be ac SITE ADDRESS �5 ASSESSOR'S TAX /PARCEL # Z 9 Z ( ° `/ - Ir ( I U LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) PROJECT INFORMATION -103 Y SF MF CO ME EL DE N FP Please print legibly (in SUITE /UNIT # "- LOT SIZE (sj) TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL >DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT NAME (Name of Business or Owner Last Name) W A.1 t, 4= PEOPLE •- • PROPERTY OWNER .b CONTRACTOR 4-APPLICANT ., PROJECT CONTACT LENDER NAME PRIMARY PHONE MAILING ADDRESS MRILINGADDRESS CITY STATE, ZIP. 9 N ADDRES e CITY, STATE, ZIP I E -MAIL ADDRESS 7? /1 i - COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ADDRESS MRILINGADDRESS CITY STATE, ZIP. CELL PHONE _ CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER ) - CONTRACTOR'S REGIETPATION NUI BER ZXPIRATION DATE E-MAIL ADDRESS COMPANY NAME 45�W 145 Ald 11-2e, APPLICANT NAME OFFICE PHONE - MAILING ADDRESS CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent ❑ Other FAX NUMBER ( - I NAME Al PRIMARY PH �(� �� •�� E MAiL ADDRESS 43 NAME �,� I per RCW 19.27.095. Lender ir{formation is required if project value exceeds 05,000 MAILING ADDRESS CITY. STATE, ZIP PHONE t - EXISTING USE SFTL PROPOSED USE moNc- EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? ❑ YES 1,iNO FIRE SUPPRESSION SYSTEM DP ❑ YES 00 WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA RIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE / 'PRIVATE (SEPTI I'fe'alI AREA DESCRIPTION E7QSTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT (A COPY OF BID OR ESTIMATE MUST BE INCLUDED LICATYON) AIR HANDLING UNITS FIRST O OUTLETS WOODSTOVES BBQS SECOND QAS WATER HEATERS MISC (Describe) BOILERS THIRD HOODS p mmmdA COMPRESSORS DUCTS ADDITIONAL FLOORS (DESCRIBE) RANGES REFRIG. SYSTEMS PLATTED LOT? PLUMBING DECK (❑ COVERED OR ❑ UNCOVERED ?) DEMO PERMIT REQUIRED? o YES BATHTUBS Iamb /sna er GARAGE ❑ CARPORT ❑ URINALS MISC (Describe) DISHWASHERS NUMBER OF FLOORS xasr°e Mom= ror`v' "nu sawn er rare" raorosso sr mnw OF ""NEW HOMES ONLY"''' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fudures�mak ilW,Cff"c4L a ALTERATION a REPAIR a TENANT DWROVEMENT Ot &r p Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED LICATYON) AIR HANDLING UNITS EVAPORATIVE COOLERS O OUTLETS WOODSTOVES BBQS FANS QAS WATER HEATERS MISC (Describe) BOILERS FIREPLACE INSERTS HOODS p mmmdA COMPRESSORS DUCTS FURNACES GAS LO �/'�_ / RANGES REFRIG. SYSTEMS PLATTED LOT? PLUMBING DEMO PERMIT REQUIRED? o YES BATHTUBS Iamb /sna er LAVE (Bath n Sbd* URINALS MISC (Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING F AINS SHOWERS WATER CLOSETS (To&q EL WATER HEATERS SINKS WASHING MACHINES . SE BIBBS SUMPS I certj g under penaky of peywy that I am the property owner or authorised agent of the property owner. I cwWy that to the best of my knowledge, the information submittal in support of this permit application is true and correct. I cert(& that I will comply with all applicable City of Federal Way regulations pertaining to the work authorised by the issuance q f 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 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 appygMon. g * I SIGNATURE: Authorized 7 o;/z27 a NEW o ADDITION a ALTERATION a REPAIR a TENANT DWROVEMENT Ot &r p BUILDING SHELL ONLY? o YES a NO BASIC PLAN? DIES o NO ZONING DESIGNATION S - 7. O CHANGE OF USE? a YES a NO NEW ADDRESS REQUIRED? o YES o NO UP /SEPA /SU? a YES a NO PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? o YES a NO Bulletin #100 — January 1, 2008 Page 2 of 4 k\Handouts\Permit Application MAY -28 -2008 06:05 From:ELECTRIC FIRST REP 2533956806 To• 0 586 0036 P.2/2 MAY -27 -2008 14:00 From: 33956806 P.3.'3 05127/2006 10:58 FAX 360 586 0039 FFG 8 E/S J1002/002 r DEF" lIQRRMCOMMM"AEY®Al1QJrfl'A=!l"M ' 33�� i• Avp�eu; Sw0! PO Box 9718 CITY OF F.drnl W*WA tM06WII ���� �� 2if�35,?�6lly;FpZ53-iii:�lD DEMOLITION PERMIT REQUIREMENTS A �mtslltim parntlt is regniead � pow say rtluab� a i Oa a ttibjeet p1+Oq�y. C>teeJc arts the Ciq's Planning lam► OR 10 See if the Proposal troaeods thrnabralds that tai w an wvh=MnuW =*view. An armmamW review aad submittal Of= OWUMnOdd dswWiat may ba mgosmd, which *+Al eatmd dw tie period bafbre a dwu9idan pmt ow be isaucd. 13 Prior to @0b0d"bW ■ dlMKtl= PIUVA the hNuwfsR toms (as appftbls) mad be wed by the raapie&e Wsel (Me attached DenfiVt % Peemft Coatnet Idstj. NOMMAMLn. At �1<Rp�p�,eirir w�svvdicra�rwN1 irwavabkpwa N&W. <the oliftowp�o�it.dilRppfA0rbl1 ftm.rr 6&tvw wr w bs rlie rypedlue = ... 1161 3. ab" sllpKY Lol (t�b be Miue OIL P� 3. in"= STSM4 fft*tMb8fG inewv a rc a W 00 dMM Md fibW 1 \-s� a*.�d, M+* M* 4. WEMY5E11 R (Check apps a bb,l n ed aC pr�erly Ilse C m rnm and be v proposed eery ebvMn aekwmw S. OAfesA,SF �eoe sad el bll pAld) o 7. PUIL (Above glM iWalta bear pimped or nmiqwW omptamt Paw& pftr t0 p WIM larlp PH am "WA) e. 11 • Mlk !babes ieu �p�Ilubla pail m be min sire *d v NI: d term rwWr# W ba p vbded *.raves OR s+.... 9.1 AlU w PdMEW WO (Cheer sw9ciMB box) oWAtavMIM�adts"d MV GWAW a"n►tn � p ' s 13 C mpbftd Cowan eves >wmtt Appli tba f0 m 17 R+ovkk the fanawtV tb=,- 1. Demewun PmMf NIc 2. Aaiomstlon Yes 5. VVA N b - Barehupe 4. Cub bond napvdt M.00 5M tse -am Qkdeaftwe"M campuw Fleit><aaperltw) H00.00 %fidn A22 -J«=r 1.280N !.p 1 vr% kiFl� /a:uilQ�wltlimrerefea.�ne:o�a4 Approved Transaction Page 1 of 1 psc I ea n air.org Puget Sound Clean fir Agency Notification Amendment #: 200801247 -2 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 $25.00 Credit Card Transaction # VLFF2D4F41AC Transaction Date 06/02/08 Owner's Name Washington State Dept of Transportation Phone (206) 768 -5713 Site Address 933 So 364th St #T Site City Federal Way Zip 98003 Contact Person Roy Syrovy Phone (360) 239 -1865 Mailing Address 6431 Corson Ave S Seattle, 98108 This project includes asbestos removal. _ .. Project Size linear feet / 960 square feet Project Start Date 06/03/08 Completion Date 06/04/08 Asbestos will be removed by a licensed asbestos abatement contractor Contractor Correctional Industries Contractor Job. # ; _ AW902 :. .._ Contact Steve Williams Phone (360) 586 -003: Mailing Address PO Box 41115 Olympia, WA 98504 This project includes a demolition. Demolition Start Date 06/04/08 Completion Date 06/05/08 Demolition will be completed by a demolition contractor Demo Contractor Correctional Industries Contractor Job # AW902 Contact Steve Williams Phone (360) 586 -002 Mailing Address PO Box 41115 Olympia, WA 98504 By submitting this Amendment: (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand the fees for this Amendment are nonrefundable. Create Another Notification View History If you have questions, contact us at asbestos @pscleanair.org or 206.689.4058. Log Out https: / /secure.pscleanair.org /Asbestos /Approved.aspx 6/2/2008 May.20. 2008 9:47AM NOW Environmental Services No, 8882 P. 1 bRiolkl Envir'onniental Services An Environmental Compliance Consulting Firm Polarized Light Microscopy Test Report EPA Method 600/R- 98/116 Client Correctional Industries Environmental Services Date May 19, 2008 PO Box 41115 Page Page 1 of 2 Olympia, WA 98504 -1115 Invoice 082004 Attu: G Brock �1' k' Date Received May y 14, 2008 Project Number AW -902; PO # ES08350 Project Name D.O.T. — Federal Way 933 -- 364" Street Federal Way, Washington Client Orion Sample Asbestos Otter Number Number Stereo Scope Exam Treatment Percent 1' a Fibers FW -01 -01 80514 -197 Gold / Yellow / White - 25 Chrysotile Cellulose Pattern Vinyl Sheeting w/ Gray Felt Baclriing & Non - Separable White Mastic Homogeneous FW -02 -01 80514 -198 Ceiling Panel - ND - Cellulose Homogeneous FW -03 -01 80514 -199 Sheetrock - ND - Cellulose Homogeneous FW -04-01 80514 -200 Vapor Barrier - ND - Cellulose Homogeneous FW -05 -01 80514 -201 White Roofing Mastic Chloroform ND - - Homogeneous FW -06-01 80514 -202 Gray Window Putty Chloroform 2 Chrysotoe Cellulose Homogeneous FW -07 -01 80514 -203 Dark Brown Wood Grain Crush ND - Cellulose Pattern Self-Adhesive Vinyl Tile Homogeneous FWS- 01 -01a 80514 -204a Black 3 -Tab Roofing Ash ND - Cellulose Homogeneous FWS- 01 -01b 80514 -204b Black / Brown / Tan 3 -Tab Ash ND - Cellulose Roofing Fiberglass Assoc. w/FWS- 01 -01a 34004 - 9'h Avenue South ♦ Suite 5 ♦ Federal Way, Washington 98003 -6740 ♦ Tacoma (253) 952 -6717 ♦ Seattle (253) 874 -8118 ♦ Facsimile (253) 927 -4714 ♦ Email lnfo@CrionES.net WBF, W2F9219763 May 20. 2008 9:47AM NOW Environmental Services No. 8882 6RI01Environmental Services An Environmental Corn lip 'ante Firm Polarized Light Microscopy Test Report EPA Method 600/R- 98/116 Clivat Correctional Industries Enviroo mental Services PO Box 41115 Olympia, WA 98504 -1115 Attn: Crary Brock Project Number Project Name Client Orion Number Number_ FWS- 01 -Olo 80514 -204c FWS- 02 -01a 80514 -205a FWS- 02-01b 80514 -205b FWS -03 -01 80514 -206 AW -902; PO # ES08350 D.O.T. — Federal Way 933 — 360 Street Federal Way, Washington Ste�cone Exam Black Roofing Felt Paper Assoc. w /FWS- 01-01a Black /'White 3 -Tab Roofing Homogeneous Black Roofing Felt Paper Assoc. w /FWS- 02 -0Ia Black Roofing Felt paper Homogeneous N. 2 Date May 19, 2008 Page Page 2 of 2 Invoice 082004 Date Received May 14, 2008 Sample Asbestos Other Treatment Percent TyPe ibers Ash ND - Cellulose _ Cellulose Fiberglass Ash ND - Cellulose Ash ND _ Cellulose Dup: Laboratory QA/QC Duplicate; M; Mastic ((a), (b), (e), etc.]: Sample layers numbered from front to back. Comments: For layered samples, each component has been analyzed separately. ND means non - detect for asbestos fibers by EPA Method 600/R -98/I 16.Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain asbestos. Thus, these laboratory results represent due diligence , however negative or <1 % PLM results can not be guaranteed. Per P-PA guidelines samples will be archived for 30 days then will be disposed of. This report may only be reproduced in full with written approval of ORYON Environmental Services. e 'ewed B Analyzed By R �' Den--- Rauschtnberg Donna McNeal Laboratory Analyst Laboratory Director, CEO Geaw- g Envimnment4rC0ncpfranca Consulting Into tfie 21St Cntwy 34004 - 0 Avenue South ♦ Suite 5 ♦ Federal Way, Washington 98003 -6740 ♦ Tacoma (253) 952 -6717 ♦ Seattle (253) 874 -8118 ♦ Facsimile (253) 927 -4714 ♦ Email lnfo@OrionES.net VV>f31F W2F9219763 4% DEPARTME* COMMUNITY DEVELOPMENT SERVICES 33325 8t° Avenue South PO Box 9718 CITY OF "'� Federal Way WA 98063 -9718 Fedel01 Way 253-835-2607; www. i Fax 253 - 835 -2609 www. ci tyoffedera Tway. com DEMOLITION PERMIT REQUIREMENTS A demolition - permit is required to remove any structure or structures an- 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 ToAPPLrc4NT. 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 ,*: fLECTRICITY (Copy of approval form and asbestos survey from Puget Sound Gean Air (Electricity to be shut off and meter removed) Agency provided) (City of Federal Way Building Offidal) YGAS SUPPLY (Gas to be shut off, meter removed and final bill paid) (Puget Sound Energy) 3. SEPTIC SYSTEM (Tank to be removed or tank to be drained and filled) (King County Environmental Services) ANITARY SEWER (Check applicable box) • Sewer line capped at property line • Existing sewer line to remain and be used by proposed new structure (Sewer District) ,,5 GARBAGE (All household r garbage disposed off a final bill paid) "tmx� (RST Disposal /Feder Way Disposal) ❑ Completed Construction Permit Application form ❑ Provide the following fees: (Puget Sound Energy) 7. FUEL STORAGE TANKS (Above or below grade fuel tanks, have been pumped or removed under Fire Department permit prior to any dismantle /excavation) (South King Fire and Rescue) .MATER - Public Source (Check applicable box) • Meter to be removed and final utility bill paid • Meter to remain and be protected (Water Supplier) * * * * ** OR * * * * ** 9. WATER - Private Well (Check applicable box) • Private well filled and capped • Private well to be used for other purposes 1. Demolition Permit Fee 2. Automation Fee 3. WA State Surcharge 4. Cash Bond Deposit (King County Environmental Services) $70.00 5.50 4.50 500.00 (Refundable upon Completed Final Inspection) $580.00 Bulletin #122 — January 1, 2008 Page 1 of I kAHandouts\Demolition Permit Requirements 05-28 -2008 15:01 From -SKING u�i1�t2008 10:58 FAX 36o 5610036 C"y OF Federal Way +2534376711 T -366 P- 002/003 F -289 ar •��w i.�i V I tt r. .S -1J FFC & E!S rb 002/002 Duwa71MT CW Co"HURn DBVgWpNM 9 333 do Avegfue South P011=971111 Federal Way WA 98063 -9718 2S3- 835 -26U7; Fax 953435.2609 WMalbMtrad DEMOLITION PERMIT" REQUIREMENTS A damalltfon pamit is regnimd to 1>Ot1 an M gnMw or t1tr1 OMMI on a eu e+cct DMISian tD sea if the proposal ==eels ti��abalda that pmpaly. Chraok with $ta City'e PWjniag ftm t� of IM �' roWcw. An envi=ozal revkw tad be issued. ch°ddzat �' be MqWred, whicb will eKtmd the time PMW befaxe a demolition permit cap ❑ prlor tD snb a daolition Pam% tila failowb kwu as e xewcY (� aft ached Demvlldsa Permh Contact Lied.' € PP1t �} meat be elgned 6y the ► tective Nora zbM. Ut/ltAlcv fJlc!! 3e be d1re� ett � servlc[s pafwivoed rl4PPitoRble, priev to Lswarrs of lhs deraolifioq yrr�y:.11l �Ileoble flmwr lbw wd �e lie help qwKy ftp►afff tr&ff L ABA A1AT1MSNr G. MC1R><Grr1r ( VWd" Iahrrrr atrtl ems srrVry hoar pypgr 80u10 t7ean Air (000* m bt e101 OR and 111a, w,,o rig trer am Ouppm (MB In be eiart off, M11er n II Pd id) wJwi MUM rr4m) a. iFRiC SyssDrl Cnwk to be nittloead or tank oa be dralmd ana titled) �� MC68 4. SNWARYS WER (Check rippllceble boa) Q saw On mined at pm" lave C EW9h0 sr*w IEtre to M110 n and be aged btr Po new *u=fe �r DLstrirs) X. OARWE 7wbr7Ge *Pmd off mud &ml Mi pain Way Di C3 oomplMd conSa a 9909 Petnoit A►pplieadden form © Provide the tbllowlgg feels j =wv 1. Wpet 7, full. WOXAIU TAPNI (Above or MOW grade ftel tents, hi lver been pumped or eennoved under " Depnrdeart penult prbt is any d1sm3fttWsxawwon) (SOUftr RM9 Fine arld M=e) & WATER a Public Saab (Check appllemblc htw) D Mem m be re .ao and Aral utllllY bel paid 0 Hebb to rarom and be pqtmad (welxr Suppeo� +s+trrr OR *Me*" 9. WATER " 0 owl Wilt fcft a 40011calge box) R Private well tilled atul capped 13 PM t8 well to be wad for oftrpurpom 9 4 ran Mi 1. Dennlidon Permit Fee 2. AQmsmdion Fee I WA Sate 9urrblrga 4. Cnab Bond Deposh Pale t of l $70.00 sin 4.50 -rsm- AR aw"dsble upon caftawo Flmr! ft path.) 5990.00 t%nftNwarrroliacn iMt 05/27/2008 10;53 FAX 380 586 FFC & I: /S !� '9002/002 ' Aasrea�aarr o>r Cbl�l�nnmr DsvRLOilmlr! 9aA�ldaa 3s325 a° '� south toa m971a City Of Federal Way WA ; 900.9913 Federal Way ��s.ZW Fail ".U.1aM DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any st a0mv or 110vcturas on t subjeot)?i"oP�!'• Cheek with the Cit), 3'laanlug Division to sea if the proposal exc" dmbolds Hitt 11da t 0% envkolSlOcublli teviaw. An *dVk aun90W roviaw and sub l of en etiv>l�emental oheeldist =y be nqubvd, which wM cttend the tiw period before a demofitio i PW t ven be inuad. O Prior to mbmittlng a 4e11110WOR parmito the Wkwing turns (n applicable) must be signed by the active ageaey (sae attabiod Detnoltdou Paz* Cantu LWs NOrd 10gAA WAfM Nf We Mall be dieconntaW and servrc"pd"ypW, VOW10klr, prmf 10 9FOM oe vltllt daeolffleK prrnnit All Who" lr� balaW a►'a m br �r•�•a a� t._..�r � flea ►edpeptivs q�ru,1' rapr+araMraNvrs 1. AnEoll ABATIMIRNT (Cove a std lbrm and atwt= svav from Pup t Sound OW Alf —(Q"q FWW"f+y' euikllnq offidaq 2. GAB SUPPLY (Can to to AM OR, nwo ramoead and final bill paid) & f9--c SYM14 (Tank to be mmvW oC Ift to be drained and ftllea) ARY SEWER (C ck applicable box) line capped at _ ko a r rw �r used br now obudurs & GARl+AOI (AEI houWWd paft W dlepeesd off ens Anal bill paid) D Compieted Construction Permit Applleadaa form 0 Provide the follOW11116 fmf BWW& +Manz —Z� 1.200i 6, ILICTRIMY (ElewlM m be shut or and mater raeVO4 . 7. full,.159'ORABE rANM d re pq�p fme FIDarhrt permit ptlorr to any dismanWoommum) �Nino rs IL WATE - rrbllf; NOM dk applicable box) MdW to a tranwln and be prooaamdlN lel3 veld i 0a06*0 OR aassss � P. WATIlt - pia wall (Check applicable box) a Pllveb: well Ailed and apped a Aiv* wall to be aced for other purposes ( 0 caum awrowwwwrEw 1. Damotitiun Parmh Fee 2. Auwmadon roe 3. WA Stab Surcharge 4. Cash Bond Deposit 5190.00 5.50 4.50 500.00 (ltdl4odablo up" Cw*lsbod VhW ttlsP m) 5560.00 10 'd 80L6 669 66Z 'ON XU ZS I Q A111 I1 n NHAVENVI WV 6V:60 GIM 8002 -H -AVA a 40+0Id Idba JN b weal JU /� �r � of. e seoedeo# UgL OWeW IUII!Wsueal xel puejq wtl,tsod 10 'd 80L6 669 66Z 'ON XU ZS I Q A111 I1 n NHAVENVI WV 6V:60 GIM 8002 -H -AVA JUL-17-2008 THU 11:20 AM Easlgate _Public Health C FAX H0, 1162964919 P. 02 Community Environmental Health Services 14350 southeast Eastgate Way Bellevue, WA 98007 -6458 206 -296 -4932 Fax 206 - 296-4919 1-rY Relay: 711 www.kingrounty.gOV/1'ealth July 17, 2008 Mel Hartsell Department of Corrections Environmental Services 9630 Blomberg St SW Tumwater, WA 98512 Re: Septic Tank and Well Decommissioning Public Health Seattle & King County Address: 933 S. 364`" St Owner: Washington State Department of Transportation Dear Mr Hartsell: This letter is to acknowledge that our office has received a copy of the �s�i hank' report form, decommissioning report form oommis ioned per K ng Co �y B and of Health Title 13, the tank has been properly 13.04.054. There is an existing well on the property that is also to be decommissioned. Based on our conversation, the well is located within a structure that must e demolished oval for the w well can be accessed. If the City of Federal Way requires rlocess.DThis letter will serve as a conditional decommissioning, it must be done in a two -step p permits to demolish the Health Department approval so that you may obtain the necessary p decommissioning. building housing the well. Once this is done, you can proceed nor to the tarting he work. The well driller must provide this office proper notification p report form, At completion, please provide a legible copy of the well driller 's decommissioning rep that point I can provide you with a letter of completion. If you have any questions not answered by this letter, please contact me at (206) 296 -9735 between 8:00 AM and 5:00 PM or leave a message on my voice mail. Sincerely, Dav��oper!�Id�,-.e Health and Environmental Investigator II Community Environmental Health DK:vo .. ®SEAM *