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07-100813City of Federal Way Demolition Permi • 07- 100813 -00 -b E Community Development Services • P.O. Box 9718 Federal Way, WA 98063 -9718 Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Request Lille: (253) 835 -3050 Project Name: WA STATE DEPT OF T11ANSP( 'T'A(T1bN Project Address: 1818 S 356TH ST r� Parcel Number: 282104 9124 Project Description: Demolition of house, garage & carport Owner Applicant Contractor WASHINGTON STATE DEPT OF DEPT OF CORRECTIONS DEPT OF CORRECTIONS TRANSPORTATION PO BOX 41116 PO BOX 41116 PO BOX 47338 OLYMPIA WA 98504 OLYMPIA WA 98504 OLYMPIA WA 98504 Additional Permit Information F I "- Ott!" [ D THIS CARD IS T%"MAIN ON -SITE ` CITY OF Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050 PERMIT #: 07- 100813 -00 -DE Owner: WASHINGTON STATE DEPT OF TRANSPORTATION Address: 1818 S 356TH ST FEDERAL WAY, WA 98003 -8305 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. 0 Final - Building (4050) Approved B Date CITY OF- `(' l Federal Way�� •i OPERMIT l - — – COMMUNM DEVELOPMENT SERVICES � s F CO ME EL PL E EN FP 333 sEOE � " "APPLI- CATION FEDERAL WAY, WA 98063 -9 O unoul.dHroJiedemlumu.com (; F FEDE�LV11A The following Iii >4lkct ° f g ��.$1 ,� ton -an incomplete application will not be accepted. Please print legibly (in PROPERTY INFORMATION SITE ADDRESS O / C.> J� j r !T 1 - SUITE /UNIT # ASSESSOR'S TAX /PARCEL # Z L LOT SIZE (sn LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) /Attach separate page far lengthy legal des -pb-) PROJECT • • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL °DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) PROJECT NAME (Name of Business or Owner Last Namel PROPERTY OWNER CONTRACTOR COPY of h application with e�c rppltertiea APPLICANT PROJECT CONTACT LENDER 0 PEOPLE INFORMATION NAME APPLICANT NAME - PHONE 1`9,iiJ s P6 ice; t} i o , 6-M-P- `t r3 rL v c 1_ c�) 7 03- - 7 3 Ca MAILING ADDRESS - X73 3 +PRIMARY CITY, STATE, ZIP IL ADDRESS CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER COMPANY NAME - APPLICANT NAME - OFFICE PHONE FP i Indicate number of each type of future to be installed or relocated as part of this project. Da not include existing fixtures to remain. Value of Mechanical Work $ (A COPY OF BID OR ES77MATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DU..CTS; BATHTUBS (or Tub /shower combo) DISHWASHERS DRINKING FOUNTAINS ELECTRIC WATER HEATERS HOSE BIBBS I certify under penalty of per am authorized by th owner of the harmless the City o eral Way as such claim) c .7 1�a; arises ou f the re oj(r�tphe` del this anv cation. NAME /TITLE EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS LOG SETS LAVS (Bathroom sinus) RAINWATER SYST SHOWERS SINKS SUMPS GAS PIPE OUTLETS WOODSTOVES GAS WATER HEATERS MISC (Describe) HOODS (Commercial) RANGES REFRIG. SYSTEMS URINALS MISC (Describe) VACUUM BREAKERS WATER CLOSETS (talky WASHING MACHINES the information furnished by me is true and correct to the best of my knowledge, and further, that I premises to perform the work for which the permit application is made. I further agree to hold y claim (including costs, expenses, and attorneys' fees Incurred in the investigation and defense of son, including the undersigned, and filed against the City of Federal Way, but only where such claim jtng its officers and employees, upon the accuracy of the information supplied to the city as a part of 7 DATE (Tide) PROJECT ❑ Owner o Agent ❑ Architect ❑ o NEW o ADDITION o ALTERATION o REPAIR ❑ TENANT IMPROVEMENT. AREA DESCRIPW EXISTINGAft SO- FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT o NO ZONING DESIGNATION FIRST CHANGE OF USE? o YES o NO SECOND o YES o NO UP /SEPA /SU? THIRD o NO PLATTED LOT? o YES a NO ADDITIONAL FLOORS (DESCRIBE) DEMO PERMIT REQUIRED? o YES o NO DECK (O COVERED OR ❑ UNCOVERED ?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS s�aartRa PROPOSED TOTAL rorsusrrxasr w roTntPROPOSEDSr To7var — NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of future to be installed or relocated as part of this project. Da not include existing fixtures to remain. Value of Mechanical Work $ (A COPY OF BID OR ES77MATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DU..CTS; BATHTUBS (or Tub /shower combo) DISHWASHERS DRINKING FOUNTAINS ELECTRIC WATER HEATERS HOSE BIBBS I certify under penalty of per am authorized by th owner of the harmless the City o eral Way as such claim) c .7 1�a; arises ou f the re oj(r�tphe` del this anv cation. NAME /TITLE EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS LOG SETS LAVS (Bathroom sinus) RAINWATER SYST SHOWERS SINKS SUMPS GAS PIPE OUTLETS WOODSTOVES GAS WATER HEATERS MISC (Describe) HOODS (Commercial) RANGES REFRIG. SYSTEMS URINALS MISC (Describe) VACUUM BREAKERS WATER CLOSETS (talky WASHING MACHINES the information furnished by me is true and correct to the best of my knowledge, and further, that I premises to perform the work for which the permit application is made. I further agree to hold y claim (including costs, expenses, and attorneys' fees Incurred in the investigation and defense of son, including the undersigned, and filed against the City of Federal Way, but only where such claim jtng its officers and employees, upon the accuracy of the information supplied to the city as a part of 7 DATE (Tide) PROJECT ❑ Owner o Agent ❑ Architect ❑ o NEW o ADDITION o ALTERATION o REPAIR ❑ TENANT IMPROVEMENT. BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? o YES o NO UP /SEPA /SU? o YES o NO PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? o YES o NO Bulletin #100— January I; 2007 Page 2 of 4 Mhandouts\Permit Application . DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 333258 1h Avenue South PO Box 9718 Federal Way WA 98063 -9718 253- 835 -2607; Fax 253 -835 -2609 www.cityoffederalwa -.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. ❑ 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 s4pned and dated by the respective agency representatives. 1.ASBESTO BATEMENT (Copy, of. approv form and as s survey from Puget Sound Clean Air Agency ro ed City of Federa ay Building Official) 2. GAS SUPPLY (Gas to be shut off, meter removed and final bill paid) (Puget Sound Energy) & ELECTRICITY rici be shut off and meter removed) (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) � t ,[—m c )t�2 -i i$Ifl 5 SS�ryS/, _ (South King Fire and Rescue) 3. SEPTIC SYSTEM 8. WATER - Public Source (Check applicable box) k to be removed o k drained and filled) ,Meter to be removed and final utility bill paid o Meter to remain and be protected 'A Z�'.cgg1 Itil`EfMUEJ LalL1 -N Dl5?(�lC� x'13N� (King County Environmental Services) (Water Supplier) * * * * ** OR * * * * ** 4. SANITARY SEWER (Check applicable box) 9. WATER - Private Well (Check applicable box) o Sewer line capped at property line o Privat well filled and cap o Existing sewer line to remain and be used by proposed new structure o Priye /gell be4wa f r ther purposes (Sewer District V1— (King ounty Environmental Services) S. GARBAGE (All household garbage disposed off and final bill paid) (RST Disposal /Federal Way Disposal) ❑ Completed Construction Permit Application form ❑ Provide the following fees: 1. Demolition Permit Fee $67.50 2. Automation Fee 5.00 3. WA State Surcharge 4.50 4. Cash Bond Deposit 500.00 $577.00 (Refundable upon Completed Final Inspection) Bulletin #122 - January 1, 2007 Page I of 1 k: \hlandouts \Demolition Permit Requirements DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8`h Avenue South PO Box 9718 Federal Way WA 98063 -9718 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 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 8'h Avenue South / PO Box 9718 Federal Way, WA 98063 253- 835 -7248 Bulletin #109 —January 1, 2007 Page 1 of 1 k: \Handouts\Demolition Permit Contact List 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 68`h 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 905 156`h 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 8'h Avenue South / PO Box 9718 Federal Way, WA 98063 253- 835 -7248 Bulletin #109 —January 1, 2007 Page 1 of 1 k: \Handouts\Demolition Permit Contact List 02/13/2007 11:41.FAX,425�481�0960 CITY OF V::k�tv Federal May WASTE MANAGEMENT N, W. r T R NA [a 002 W 003/003 DiPARTHEW0FCOMMuMl9 vDX"L0PMWrSa1 "=5 33325 S*Avenue South j PO goo 9716 f Pcd"sl Way WA 98063 -9719 2"35-2507; Fax 253 -935 -2609 DEMOLITION PERMIT REQUIREMENTS A demolition pmnh is mqulmd to tetloove any atruotune or stittoiwcs on �swbjaa Rr PwY• Check with the City's Planning Divisions to see if the proposal ©eceeds threnholds that tt3gger an en ' UU TeviOW. An catVftV6ra=ftl renew and be aubmatW an cnviz+ ul cboakliat rmy be r qua, W19011 WiH mctrA ft d1ne period bei re a dewlitivn Porrrrit oan 13 Prior to aabudtdng a clemendon permit; the followilgo ltm's (aa alipliryltbie) must be rdgntld by the reepoclive agency (sea atteebed De OHdon permit Contact List). Nara Tie APMC41M iltilifkv slraJl bs dlteonnrmad and mWe srp proW,'VgppV= e. PH OF to 1 anoe of rbe deAaoll aM porn tt. Al! gppftoa6Je A&M 6elew era to be Y the eapse due figeady mpra auffuyes. 3. ASSES1'+OS AHAT'EMCNT Pff of spar" lam and atesics survey lham K" Sound Clean Air Ageecy provided) (9 W! of Ml E1 1)1 2. GAS SUPPLY (GW to 151'01M OF, meter removed and Rrdd hilt as* Puget S. SEPTIC SYSTEM Crank to be removed or tank m be drained and filled) 0*9 couw OR rann'afrrol Ski 4, SANITARY SI:W9R (Check applicable box) o Sewer one cooped at property line o Ong sewer 9ne to remain.end•be UM by p mpowd now etruft rit (SeW1! , 5. GARBAGE (Ali hmashoid awbwe of Aral dll =AppMemaOfta 0 Completed Constrtictinn P form 13 Provide the following fees: I. Demolition Pemit F 2. Antomadoin Pee 1 e. e (eaeLrW to bP snot of and meta removed) I (Puget sound 7. FULL GE TANKS (Above or bej w grade fuel.tank4 Reve b"n pumped or roMM under Fn D ,Mfttnit perrtilt prior to any disrnande/attava m) L WATER rb"" Sewree (Cheek applicable box) o Meter to be vVed and MW utility bill paid D Meter to and ne prUtmimd OR •�rsse.e+ 9. WATERt Wq� W'all� Check applicable box) o PHvOt1 wal and capped b ie be used for other purposes 3. WA State Surcharge 4.:b 4. Cwh Bond Deposh so (Retaudsble upon Completed Final Inspection) SOUP 9idWM #I n -)Mary t, 2M7 Yeas 1 or 1 I k- WandoutsMfimaltt 0h RarRit Rquhrre* i 02 -13 -2007 14:04 From -SKING +25343767110 T-944 P.001 /001 F -660 AAL DEPARTMENT of COMMUNITY DEVELOPMENT SERVICES ee��� , X 33325 8" Avenue South CITY OF 4 C' & -o(,{L PO Box 9718 F-ederalWay .2/ -o ' s��_ oO� Federal Way WA 98063 -9718 �OIX Jli/ �D 253- 835 -2607; Fox 253 -835 -2609 w�vw,citvoffcdcr.�lwxv com 315W+ sl . 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 be issued, time period before a demolition permit can ❑ Prior to submitting a demolition permit; the following items (as applicable) must be signed by the respective agency (see attached Demolition Permit Contact Dist). . NorE ro,rrp,&tc .4ivrr 4101ities shall be disconnected and services pe(rarmed, .Applicable. prior to isevahea ojthe demolition permit. irenu below are to be mired a dal by the respective ngezcy representatives. All applicable L ASBESTOS ABATEMENT (Copy of approval form and asbestos survey from Puget Sound Clean Air Agency provided) (City of Federal Way Building official) 2. GA P r*—moved 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) 6. ELECTRICITY �0-ItIe }hut off and meter removed) r (Puget Sound Energy) 7. FUEL STORAGE TANKS (Above or below grade fuel. tanks, have been pumped or removed under Fire D partment permit, prior to any dismantle /excavation) (South IGng Fire and Rescue) S. WATER - Public Source (Check applicable box) ,(Meter to be removed and final utility bill paid Q Meter to remain and be protected (Water Supplier) 4. SANITARY SEWER (Check applicable box ) » * * * ** OR * *** �`* D Sewer line capped at property line 9. WATER - Private Well (Check applicable box) ° Existing sewer line to remain and be used 0 Private Well filled and capped by proposed new structure a Private well to be used for other purposes 5 3 07 5. GARBAGE (Sewer ..m., ILA) (King County Environmental Services) (All household garbage disposed off and final bill paid) MST Disposal /Federal way Disposal) 11 Completed Construction Permit Application form ❑ Provide the following fees: Bulletin 11122 1. Demolition Permit Fee 2• Automation Fee 3. WA State Surcharge 4. Cash Bond Deposit $67.50 5.00 4.50 500.00 (Refue�dable upon Completed Final inspection) $577 -00 Pugc i or 1 kAl- landouts0emolidon Prrmit AdOLL Agency Case No. PUGET SOUND CLEAN Date Received AGENCY 110 Union Street, Suite 500 p s c ! e a n air. o r g Seattle, WA 98101 -2038 Agency Use only NOTICE OF INTENT Agency Use only Type or print clearly ♦ U..,.:....s T.,..... 1 n L`..:..l.le A..L.o.. +. D­ 1 7 5d T.'.io}.lo. A.1—f— RPmnvnl R, l7P.mnlition 3. ❑ Demolition Onlv B. Property Owner: Z Pori,— PhoT 3L0) 705- 73S 'o risF S' P; c)� n-va, —------- - - - - -- phone- ( 3d 0) 5 Re- coo 3 o Mailing Address: City: State Zip: 0 30� 733 g 0Z_Y."P/e9- wA-5Nf %FISH C. Asbestos Contractor: 1f°t3( C. S. Xi Owner /CEO: 1 / Y"ti�/�SGltle�Cr- - - - - -- - -- —------- - - - - -- phone- ( 3d 0) 5 Re- coo 3 o - - -- Contractor Job No.: A i.-J i V -- - -, _ - - - -- - - - -- - -- ..�—-------------- Mailing Address: 1 -3 L-1 i i I & City: Gt_ ' e-7 I State: w/1- S Zip: o Fax:('" , o —i i - 003 C D. Site Address: City: Zip: Contact Person: R o S `l it J v 1 1 Local Phone: (3 6 0} Z3'1- 1 S6 -5-- E. ffAsbestos Survey or No. of Structures: Date of Asbestos Survey: / Was Friable Asbestos Identified? 21Yes ❑No Mat'l Presumed Date: � / 0 I 2- Was Nonfriable Asbestos Identified? ❑Yes ❑No AHERA Building Inspector: Certification #:3 f O9 -06 1 Y $ 6_ &t?- /3 2 G C !L_ Exp. Date: j2-/?,2-/c,7 ec) " A-ic-�"I i o Jai_ i /-),p Lt S jTL t A.. ALiFAA Q . ­;­4 ,.na,..,,r;t;,, f� F. Demolition Start No. of 720 Training Fire (List Fire Dept.) Information Date: � / 0 Structures: 1 Ordered Demolition attach co of Order Demolition Insert demolition contractor's mailing address on back. Will nonfriable asbestos be left in place during demo? LJ Yes X No Contractor: If yes, list type and qty. Note disposal requirements in Step 6 (on back). ec) " A-ic-�"I i o Jai_ i /-),p Lt S jTL t G, Friable Asbestos Start Date: Co m letion ate: Work Days: QDT W Th F Sa Su Project Information: .Z iz 0 -7 2. j Z 0 Hours: `! 3c A - '3'-- P Will all friable asbestos Yes ❑ No Total Qty. to be Removed: Linear Ft. Square Ft. B. $50 materials be removed? H. Asbestos/Demolition Project Categories: Notification Period Project Demolition 1. Single - Family Residence (owner- occupied): A. Prior Notice Fee Surcharge A. ❑ Asbestos Removal Project Only B. 10 Days* A. $25 B. ❑Demolition Project (with or without asbestos removal project) B. $50 *(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 singlefamily residence does not include rental proper , multi-family units, or a mixed -use building. 2. ❑ All Other Demolitions (with no Asbestos removal or Nonfriable Asbestos 10 Days $50 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. At >_ 10 - 259 linear feet and/or >_ 48 - 159 square feet of asbestos Prior Notice 10 Days $50 $50 4. ❑ 260 - 999 linear feet and/or 160 - 4,999 square feet of asbestos 10 Days $200 $50 5. ❑ >1,000 linear feet and/or >5,000 square feet of asbestos 10 Days $600 $50 6. ❑ Emergency Asbestos Project or ❑ Emergency Demolition Project Prior Notice $50 Emergency Fee (Single—Family (Single-FaTily Residences are exempt from emergency fee; however, property owners must provide a written emergency request) If I. I ce tat the informat' n :ahned in this ification & supplemental data is, to the best of my knowledge, accurate & complete. Agency Use Only 60 "1A j c T>o,✓r1 i %rJ 2? D Signature Representing Date 66-160 Notice of Intent (Revised 11/06) LSS 1 of 2 The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project involving materials equal to or greater in size than 10 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. J. Demolition Contractor: eJ gLA4 _cnr rr v} i 1i v u 5 i fL t 0. �_,> Owner /CEO: �-- f Mailing Address: v� l -1 j ] (�, Phone: � 3 1 cJ S� v o cs Contractor's Job #: A`''J yY I— — 81- 00.3 6 - - -- 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. 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 quests must be accompanied by a letter from the property owner demonstrating the need to conduct the proiect 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. 66-160 Notice of Intent (Revised 11/06) LSS 2 of 2 Jan. 24. 2007 4:24PM NO k Environmental Services 0 No. 1914 P. 2/4 ORIONEnvironmental Services An Environmental Compliance Consnitin Firrn Polarized Light Microscopy Test Report EPA Method 600/R- 98/116 Client Correctional Industries Environmental Services Date January 24, 2007 PO Box 41115 Page Page i of 3 Tumwater, WA 98504 Invoice 070322 Attn: Gary .Brock Date Received January 24, 2007 Project Number PO # ES000468 Project Name D.O.T. — Federal Way 1818 — 356h Street Client Orion Sample Asbestos Number Number Stereo Scope Exam Treatment Percent Type Other Fibers 1818 -01 -01 70124 -74 Wall / Ceiling Texture - ND - Cellulose Homogeneous 1818 -01 -02 70124 -75 Wall / Ceiling Texture - ND - Cellulose Homogeneous 1818 -01 -03 70124 -76 Wall / Ceiling Texture - ND - Cellulose Homogeneous 1818 -01-04 70124 -77 Wall / Ceiling Texture - ND - Cellulose Homogeneous 1818 -01 -05 70124 -78 Wall / Ceiling Texture - ND - Cellulose Homogeneous 1818 -02 -01 70124 -79 Brown Vinyl Sheeting w/ - ND - Cellulose Green Pelt Backing Homogeneous 1818 -03 -01a 70124 -80a Dark Gray / Black Vinyl - ND - Cellulose Sheeting Homogeneous 1- 818- 03 -01b 70124 -80b Brown Mastic Chloroform ND - Cellulose Assoc. W/ 1818- 03 -01a 1818 -04 -01 70124 -81 Sheetrock - ND - Cellulose Homogeneous 1818 -05 -01 70124 -82 Joint Compound - <1 Chrysotile Cellulose Homogeneous 1818 -06 -01 70124 -83 Vapor Barrier Ash ND - Cellulose Homogeneous 1818 -07 -01 70124 -84 Brown Counter Top Mastic Chloroform ND _ Cellulose 34004 X %%u§outh ♦ Suite 5 • Federal Way, 'Washington 98003 -6740 ♦ Tacoma (253) 952 -6717 ♦ Seattle (253) 874 -8118 ♦ Facsimile (253) 927 -4714 • Email Info @OrionES.net WBE W2F9219763 Jan. 24. 2007 4:24PM NOcki Environmental Services 0 No. 1914 P. 3/4 ORIONEnvironmental Services An Environmental Compliance Consulting Firm Polarized Light Microscopy Test Report EPA Method 600/R- 98/116 Client Correctional Industries Environmental Services Date January 24, 2007 Page 2 3 PO Box 41115 Page of Tumwater, WA 98504 Invoice 070322 Attn: Gary Brock Date Received January 24, 2007 Project Number PO # ES000468 Project Name D.O.T. — Federal Way 1818 — 356`h Street Client Orion Sample Asbestos Other Number Number Stereo Scope Exam Treatment Percent Trine Fibers 1818 -08 -01 70124 -85 Vapor Barrier Ash ND - - Homogeneous 1818- 09 -01a 70124 -86a Fire Brick Crush ND - Homogeneous 1818- 09 -01b 70124 -86b Grout Crush ND - - Assoc. W/ 1818 -09 -01 a 1818 -10 -01 70124 -87 Fire Brick Crush ND Homogeneous 1818 -11 -01 70124 -88 Fire Brick Grout Crush ND Homogeneous 1818 -12-01 70124 -89 Duct Tape Tease ZO Chrysotile - Homogeneous 1818 -13 -01 70124 -90 Black Built Up Roofing Ash ND - - Homogeneous 1818 -14 -01 70124 -91 Black Composite Roofing Ash ND - Cellulose Homogeneous 1818,15 -01 70124 -92 Black Roofing Felt paper Ash ND - Cellulose Homogeneous 34004-9 th Avenue South * Suite 5 ♦ Federal Way, Washington 98003 -6740 • Tacoma (253) 952 -6717 ♦ Seattle (253) 874 -8118 ♦ Facsimile (253) 927 -4714 ♦ Email Info @orionFS.net WBE W2F9219763 Jan.24. 2007 4:24PM cki Environmental Services , No.1914 P. 4/4 ORIONEnvironmental Services An Environmental Compliance Consulting Firm Polarized Light Microscopy Test Report EPA Method 600/R- 98/116 Client Correctional Industries Environmental Services Hate January 24, 2007 PO Box 41115 Page Page 3 of 3 Tumwater, WA 98504 Invoice 070322 Attu: Gary Brock Date Received January 24, 2001 Project Number PO # ES000468 Project Name D.O.T. — Federal Way 1818 — 35e Street Client Orion Sample Asbestos Other Number Number Stereo Scone Exam _Treatment Percent hMe Fibers Dup: Laboratory QA/QC Duplicate; M; Mastic [(a), (b) (c), etc.]: Sample layers numbered from front to back. Comments: For layered samples, each component ltas been analyzed separately. ND means non - detect for asbestos fibers by EPA Method 600/R-99/116. Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain asbestos. Thus negative PLM results cannot be guaranteed. Per EPA guidelines samples will be archived for 30 days then disposed of. This report may only be reproduced in full with written approval of ORION Environmental Services. Analyzed By U" Reviewed By Nelson B. Miles M ken Clark Sr. Industrial Hygieoist Laboratory Analyst Leadutg Tnamnmcntaf CoPrwnce Consulting Into the 213-t Century 34004 - 91h Avenue South ♦ Suite 5 • Federal Way, Washington 98003 -6740 ♦ Tacoma (253) 952 -6717 • Seattle (253) 874 -8118 ♦ Facsimile (253) 927 -4714 ♦ Email Info @OrionES.net WBE W2F9219763