09-101250rdierat Vl y — —
�, .�„�P 3BI� PERMIT a�'� SF MF CO ME EL PL E( kN FP
333Y58 ^IAIBM/B.Spp/�,•POB01(g(�PR 0 2 2009
S34US-2W7 WA 53435 6 APPLI CATI O N
?53.83SY607• FAX 253 -B�ri ?609
FEDERAL WAY
The jottoming is &*006 cation — an bwonepisa appUcation wiu not be accepteaL Ptsaae print tegibbi fin +n%5) a' tjW&
ASSESSOR'S SUITE/um 0
a
LEGAL DESCRIPTION leg. Acme &kae.% Lot 1)
PROJECT INFORMATION
is _ •
PEOPLE INFORlIATION
P:11, Rawl
OWN1;R
NAME
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PRp1AR! PHONB
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NAHMO ADDRESS C[IY, -STATE, ZIP
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MAILING ADR ESS
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L
CELL NE
COMPANrYNAME
APPLICANT NAME
OFFICE PHONE
b
RELATIONSHIP TO PROJ ECT
27
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MAILING ADR ESS
Y j
CITY, STATE, ZIP
CELL NE
C1T1f OF WAY HU UCZNU NUMBER
EXPIRATION DATE
FAX NUMBER
CONTRACTOR'S TRATION NUAUM—
amnRamm DATE
E-MAIL ADDRESS
COMPANY NAME APPLICANT NAME
OFFICE PHONE
MAQ Il7O ADDRE33 CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJ ECT
CITY, STATE, ZIP PHONE
0 Architect ❑ Tenant O Agent o Other
FAX NUMBER
( I -
pR�MARV PHOxe E.W, DR
t (2e-21 7_? 2, - 4,)-7n
NAME
Per RCW 19.27.095:
Lehr W° °n is regnb sd If pvjee ufte wwoo s $5,009
MAILING ADDRESS
CITY, STATE, ZIP PHONE
EEM=G USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ E
VALUE OF PiOOPOQ� WORE
BPRI
"m4,m RED BUILDIIY4&7 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? O YES ❑ NO
WATER SERVICE PROVIDER a LANWAVEN o HIaffi•INE o TACOMA a PRIVATE (WELL)
SEWER SERVICE PROVIDER 13 LABEHAVEN 0 HIcauLlim ❑ PRIVATE (SEPTICI
AREA DESCRIPTION
E3MST1NG
. FT.
PROPOSED
So. FT.
TOTAL
SQ. FT.
BASEMENT
o YES o NO
BASIC PLAN?
FIRST
a. NO
ZONING DESIGNATION
SECOND
CHANGE OF USE?
a YES
a NO
THIRD
a YES a NO
UP /SWA /8U
ADDITIONAL FLOORS (DESCRIBE)
a NO
PLATTED LOT?
a YEB a NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERJUT REQunm?
a YES
a NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
rawseuio
wecwoam
Tam
nor -ms ar
10mc02oroaasar
noNcar
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fbdure to be installed or relocated as part of this project. Do not include existing f acres to rwnavL
AEMCBAAIICAL
Dahm of Mechanical Work $ to COPYOFBlD OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLD11B ING
BATHTUBS (.rTW=n c.me.(
DISHWASHERS
DRINKING FOUNTAINS
ZLMC FaC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
LAYS pmd. m m"
RAINWATER SYST
SHOWERS
SLNKS
SUMPS
GAS PIPE OUTLETS
QM WATER HEATERS
HOODS (cagy
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (r i q
WASHING MACHINES
WOODSTOVES
MISC ( Descnbe)
MISC (Describe)
I cart(& under pau tg of pafurg that I am the properly owner or authorized a� o property owner. r cwtylr that to the best o. f my
knoaI fg% the ivjbrnmdm subseftead in support Rf this Pwm t apprtoaaon cwtw that I MUZ comply with aU cpptieabte
City R f Awdwat was regulations porta6ning is the mew k a uthortud bg the issuance of a pamtt: I understand that the issuance of this penwie
does not remove the comes rrvponsfb1 ft for compliance with local, stat@6 or federal Tawas reguk tee construction or a nstronmentui Iowa
I,fkro w agree to hold harmtas the City of Federal way as to mW claim ftneluding costa, acpansea, and auwwwgje fees incurred in the
tnsesEtgatiowe and dunce of such clot-), be any pwsow, including the undersigned, and ,filed against the city, but only
wive such clan n arises out of the re a 0496 its ojp— and empkToom6 upon the of the information supptted to
the eft as apart wt f this app
a NEW a ADDITION
a ALTERATION
a REPAIR a TENANT ID[PROVEMENT
BQILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
a YES
a. NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQU'I]RED?
a YES a NO
UP /SWA /8U
a YES
a NO
PLATTED LOT?
a YEB a NO
DEMO PERJUT REQunm?
a YES
a NO
Bulletin #100 — January 1, 2009 Page 2 of 4 bHondoutsTermit Application
Notification for Contractors roperty Owners
psc lean air.org
Asbestos / Demolition Notification
for Contractors and Property Owners
Fee Information:
Pagel of 3 ` I
(Fees Last Revised 7/1/2008)
After payment, Asbestos Demolition
Project Categories when can I start Fee Fee
my project?
Single - Family Residence Project
Asbestos removal only lToday
Demolition (with or without Demolition - In 10 Days $0 $75
asbestos removal) I Asbestos Removal - Today
Project other than Singh - Family Residence
with < 10 linear feet and /or Demolition - In 10 Days $0 $75
< 48 square feet of friable asbestos
>= 10 - 259 linear feet and /or lAsbestos Remova( - T,.(I $75"
>= 48 - 159 square feet of asbestos IlDemolition - In 10
1260 - 999 linear feet and /or In 10 Days $250 $75
160 - 4,999 square feet of asbestos
1>= 1,000 linear feet and /or In 10 Days $750 $100
>= 5,000 square feet of asbestos
If your project is an Emergency, an additional fee may apply.
Eme enc Demolition or Ta pplicable fees + $50
r9 Y Emergency Asbestos Removal*
*Single - family residences are exempt from the emergency fee.
Please enter the following:
owner's Name Thanh Tran
Site Address 2641 s. 298th street
Site City Federal Way
Contact Person Tran
RECEIVED
APR 0 2 2009
CITY OF FEDERAL WAY
CDs
Phone( 253 ) 223 -5777
Zip 98003
Phone( 253 ) 223 -5777
If the property owner's mailing address is different from the site address, enter the mailing address:
https:H secure. pscleanair .org /Asbestos/Notification.aspx
4/2/2009
Notification for Contractors 40 Property Owners Page 2 of 3
Mailing Address 30348 24th PI. S
Mailing City Federal Way State Washington Zip 98003
This is a single - family residence project. The structure is used by one family who owns the property as their
domicile. See the full definition to the left.
This project includes multiple structures in a contiguous area.
If multiple structures are part of this project, enter each structure's number and street address in the following section:
Asbestos will be removed as part of this project.
If asbestos will be removed, complete the following section:
Quantity of friable asbestos to be removed:
linear feet square feet
Project Start Date Completion Date
This asbestos removal will be completed by:
i
the property owner
the following licensed asbestos abatement contractor
Contractor Thanh Tran Contractor Job #
Contact Tran Phone( 253 ) 223 -5777
Mailing Address 30348 24Th PI S.
Mailing City Federal Way State Washington Zip 98003
A demolition will occur as part of this project.
If a demolition will occur, complete the following section:
Demolition Start Date 04/03/2009 Completion Date 04/07/2009
This demolition will be completed by:
the property owner
the fire department
the following demolition contractor
Demo owner
Contractor
https: // secure. pscleanair .org /Asbestos/Notification.aspx
Contractor Job #
4/2/2009
ii
Notification for Contractors 0Property Owners '
10 Page 3 of 3
Zontact Tran Phone ( 253 ) 223 -5777
Mailing Address 30348 24th PI s.
Mailing City Federal Way State Washington Zip 98003
This is an emergency project.
If this project is an emergency, select the reason that best describes your situation:
There was a sudden, unexpected event that resulted in a public health or safety hazard.
The project must proceed immediately to protect equipment, ensure continuous vital
utilities, or minimize property damage.
Asbestos - containing materials were encountered that were not identified during the asbestos
survey.
The project must proceed to avoid imposing an unreasonable burden.
By submitting this notification,
(1) I certify that the information I have provided is to the best of my knowledge true and accurate.
(2) I understand that I must file an Amendment to this Notification if:
• The type of project has changed. The project types are asbestos and demolition.
• The quantity of friable asbestos to be removed meets a larger project category.
• The project's start or completion date has changed.
(3) I understand that the project's site address cannot be modified and additional structures may
not be added to a notification by Amendment.
(4) I understand the fees for this Notification are nonrefundable.
Submit Notification
If you have questions, contact us by or phone at 206.689.4058.
https:H secure. pscleanair .org /Asbestos/Notification.aspx
4/2/2009
Good Faith Asbestos Survey
Appendix #B
FIELD IIATA / LABORATORY RESULTS
RECEIVED
APR 0 2 2009
CITY OF FEDERAL. WAY
CDS
Assured Quality Environmental Inc.
Mar.19. 2009 1:59PM NOW Environmental Services No-2514 P. 1
ORIONEnvironmental Services
An Environmental Compliance Consulting Firm
Polarized Light Microscopy Test Report
EPA Method 600/R- 98/116
Client Assured Quality Environmental, Inc.
2702 "A" Street
Tacoma, WA 98402
Project Number N/A
Project Name 2641 South 298"' Street
Federal Way, WA
Client Orion
Number Number Stereo Scope Exam
Date March 19, 2009
Page Page 1 of 1
Invoice 091065
Date Received March 18, 2009
Sample Asbestos Other
Treatment Percept Tyke Fibers
KH -Ola 90318 -60a Joint Compound - ND - Cellulose
Assoc. w/ KH -01 b
KH-01b 90318-6Ob Wallboard - ND - Cellulose
Homogeneous
K.H -02 90318 -61 Laminate Wall Sheeting - ND - Cellulose
Homogeneous
KH -03a 90318 -62a Joint Compound - ND - Cellulose
Assoc. w/ KH -03b
KH -03b 90318 -62b Wallboard - ND Cellulose
Homogeneous
KH -04 90318 -63 Roofing Paper Ash ND - Cellulose
Homogeneous Fiberglass
KH -05 90318-64 Roofing Paper Chloroform ND - Cellulose
Homogeneous
Dup: laboratory QA/QC Duplicate; M; Mastic [(a), (b), (c), 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 /116.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 EPA 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 ORION
Environmental Services.
Analyzed By
0-
U40 .4.Li6e Reviewed By
Dennis Itauschenberg Donna McNeal
Laboratory Analyst Laboratory Director / CEO
Lea,fvW q nmkwtmentud Compftance Consulting into tfie 2111 Century
34004 - 9 "' Avenue South ♦ Suite 5 ♦ Federal Way, Washington 98003 -6740
♦ "facoma (253) 952 -6717 ♦ Seattle (253) 874-8118 Facsimile (253) 927 -4714 ♦ l;mail lnfo @,0ri0nES,,)et
WBE W2F9219763
1
l
,. ., vnm�nlIAI UC)fILCJ
r
No. M9
P. i
Z d �[SZ ON S;)IA1aq IPIUMUOIIAUa AMM IAlJ4('I .Gnn7 1 1 - inm
l
Good Faith Asbestos Survey
SCOPE OF WORK
On March 17th , 2008 Assured Quality personnel conducted a "Good Faith" asbestos
survey (per U.S.E.P.A. /A.H.E.R.A. guidelines as designated and specified by Puget
Sound Clean Air Agency and Washington State Labor & Industries) of a small house and
detached shed located at 2641 South 298th Street, Federal Way, WA.
Field inspection, data collection and report generation were based on the following Scope
of Work:
Perform visual inspection to identify and inventory all accessible suspect -
asbestos containing materials.
Bulk sampling and analysis of all identified suspect asbestos - containing
materials.
• Provide written report.
BASIC CONSTRUCTION
The dwelling is a one story single family dwelling the date built is unknown. It appears
that the structure originally was not designed for human occupancy and then had multiple
remodels performed over the years. This survey also covers a small detached wood shed
which is approximately 200sf one level.
HEATING AND VENTILATION SYSTEM
No heating system was discovered.
PLUMBING SYSTEM
The plumbing is metal piping.
INTERIOR CONSTRUCTION. FINISHES AND FLOORING
Interior Construction Finishes, and miscellaneous: Inside construction are wood,
cellulose wallboard, and dry wall. The dry wall and taping materials were sampled as per
AHERA protocol.
SAMPLE METHODS AND LABORATORY INFORMATION
A walk through inspection of all areas was performed to identify which building
materials may have the potential for containing asbestos.
After identifying the suspect asbestos - containing materials, bulk samples were collected,
placed in plastic bags, numbered and recorded. Care was taken to clean all tools between
sampling in order to avoid cross - contamination. The samples and appropriate chain of
Assured Quality Environmental Inc.
Good Faith Asbestos Survey
custody forms were then sent to Orion Laboratories to be analyzed for the type and
content of asbestos, if any. The samples were analyzed using Polarized Light Microscopy
(PLM) Stain Dispersion Technique in accordance with EPA Methods 600 /R- 93/116.
The following section contains tables listing all materials sampled by location,
description, type, asbestos percentage (if any) category, and results of materials sampled.
SUMMARY OF MATERIALS FOUND POSITIVE
Upon completion of the survey and review of the laboratory data, the following materials
were found to contain asbestos at the structures designated at 2641 South 298th Street,
Federal Way, WA.
No samples associated with this structure contain asbestos.
Any additional hidden or covered suspect materials, discovered during demolition or
renovation, that are similar to those identified in this survey must be treated as asbestos -
containing materials unless determined otherwise by laboratory analysis.
CONCLUSION
Abatement and disposal of asbestos - containing materials must be conducted by a
Washington State Licensed Asbestos Abatement Contractor using Washington State
Certified Asbestos Abatement Workers. Should employees or contract personnel
encounter any suspect asbestos - containing materials, it is their responsibility to:
• Contact a representative of the owners.
• Consult the inspection report to determine whether or not the suspect material
contains asbestos.
• Ensure that all employees and contractors are informed and advised of the
location and type of materials that contain asbestos.
Note: Assured Quality Environmental does not guarantee approximations of quantities of
ACM, which may be listed with the analysis. It is therefore recommended professional
abatement price and/or disposal quotes be obtained by inquiring as to fees per area of
specific ACM material (i.e. square or linear foot, etc.), or by site assessment.
Any and all materials identified as ACM in this report must be abated prior to ACM
disturbance, renovation, or demolition. All materials identified as ACM must be
professionally abated by a licensed asbestos abatement contractor prior to any
disturbance.
A copy of this report should be kept on site during any asbestos abatement, renovation, or
demolition.
Assured Quality Environmental Inc.
Good Faith Asbestos Survey
Please contact the undersigned for any further assistance or if any questions or concerns
arise relative to this report.
Sincerely,
Andrew Mantonya
AHERA Building Inspector
3508- 08 -01 -01
Expiration Date January 9, 2009
Assured Quality Environmental Inc.
Good Faith Asbestos Survey
DEFINITIONS
Asbestos means the asbestiform varieties of Actinolite, Amosite (Cummintonite-
grunerite), Tremolite, Chrysotile (Serpentine), Crocidolite (Riebeckite), or Anthophyllite.
Asbestos - Containing Material means any material containing more than one percent
(1 %) asbestos as determined using the method specified in EOA regulations (Polarized
Light Microscopy).
Friable means materials that can be crumbled or reduced to powder by hand pressure.
Homogeneous Areas means an area which appears similar throughout in terms of color,
texture, and date of materials application.
Miscellaneous Materials means interior building material on structural components,
structural members of fixtures, such as floor and ceiling tiles, and does not include
surfacing material or thermal system insulation (AHERA definition).
Surfacing Material means material that is sprayed -on, troweled -on, or otherwise applied
to surfaces, such as acoustical plaster on ceilings, and fireproofing materials on structural
members, or other materials on surfaces for acoustical, fireproofing, or other purposes
(AHERA definition).
Thermal System Insulation means material applied to pipes, fittings, boilers, breeching,
tanks, ducts or other interior structural components to prevent heat loss or gain, or water
condensation, or for other purposes.
Assured Quality Environmental Inc.
Good Faith Asbestos Survey
Appendix #A
INSPECTOR'S CERTIFICATION
Assured Quality Environmental Inc.
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ASSURED QUALITY
ENVIRONMENTAL INC.
SITE INSPECTION REPORT
ASBESTOS "GOOD FAITH" SURVEY
PROPERTY
(1) SINGLE FAMILY DWELLING
Mobile Homes
2641 So. 298th Street
Federal Way, WA
PREPARED FOR:
Khanh Tran
DEPARTMENNOF COMMUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
PO Box 9718
CITY OF Federal Way WA 98063 -9718
FederalWay 253 -8 www. i Fax253- 835 -.co r ww•w.cityoffederalway.com
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 signed and dated by the respective agency representatives.
1. ASBESTOS ABATEMENT & ELECTRICITY
(Copy of approval form and asbestos survey from Puget Sound Clean Air (SectriG ty to be shut off and meter removed)
Agency provided) \
(City of Federal Way Ong Official)
2. GAS SUPPLY
(Gag-0 be shut off, meter removed and final bill paid)
3. SEPTIC SY
(Tank to be removed o nk to be drained and
4. SANITARY SEWER eck ap 'cable box)
• Sewer line capped at perty line
• Existing sewer lin remain and be used proposed new structure
(Lakehaven Utility District) "
S. GA AGE
(All sehold garbage disposed off and final bill paid)
(Waste Management/Other Company)
❑ Completed Construction Permit Application form
7. FUEL STORA TANKS
(Above or below gra fuel tanks, have been
under Fire Department rmit prior to any
S. WATER - Public Source k applicable box)
❑ Meter to be removed and fi utility bi id
❑ Meter to remain and be p9a6ded
(Water Supplier)
* * * * ** OR * * * * **
9. WAT/-rnivate Well (Check applicable ❑ Privyaate capped �% mrP ate r) for othe�rposesy%
r
or removed
❑ Provide the following fees: 1. Demolition Permit Fee Based on valuation. See table on pg 4 of the construction permit application.
2. Automation Fee $6.00
3. WA State Surcharge $4.50
4. Cash Bond Deposit 120% of calculated building permit fee
Refundable upon Completed Final Inspection
Bulletin #122 — January i, 2009 Page 1 of 1 kAl- landouts \Demolition Permit Requirements