06-103934 e •
City of Feddra'Way • Demolition Perm • 06-103934-0070E-
Community Development Services . �
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253)835-3050
Project Name: VILLA ESPERANZA
Project Address: 31524 28TH AVE S Bldg A Parcel Number: 092104 9151
Project Description: Demolition of existing 4-unit building
`
Owner Applicant Contractor
MARIO PAREDES BUCHANAN GENERAL CONTRACTOR CO BUCHANAN GENERAL CONTRACTOR CO
VILLA ESPERANZA,LLC 11408 NE 2ND PLACE BUCHAGCI59CF 04/01/2008
3808 S ANGELINE ST PO BOX 40069 11408 NE 2ND PLACE
SEATTLE WA 98118 BELLEVUE WA 98004 PO BOX 40069
BELLEVUE WA 98004
Additional Permit Information
PERMIT EXPIRES Thursday, August 7, 2008
Permit Issued on Tuesday, August 8, 2006
I hereby certify that the above information correct and that the construction on the above described property and
the occupancy and the u will t( in - c•rdance with the laws, rules and regulations of the State of Washington
and the of Federal Way.
Owner or agent: � Date: O �. G
f
THIS CARD IS TO REMAIN ON-SITE
CI OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 06-103934-00-DE
Owner: MARIO PAREDES
Address: 31524 28TH AVE S Bldg A
FEDERAL WAY, WA 98003-5503
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 c vered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On-going inspections
\is
are ogged on the back of this card.
Final-Building(4050)
� Approved
�
Byre I Date i(ato0 Q
,
0
V
.
• • , _
IP
��.oF
AUG o82a
Federal Way WAY
COMMUNITY DEVELOPMENT GF FEDERAL�Na SF MF CO ME EL P DE EN FP
33325 DEftAL WAY,WAIN•PO 9718 )►►..DING DEAPPLI CATI O N
FEDERAL WAY,WA 93039.9718 / /
253-835-2607•FAX 2534335-2609
www.cituofkderaIwou.com
The , is -, fined , . - . , -an Inco -tete -%,-licatlon will not be • .. -ted. Please - t ler • or •.)- .
C
MI PROPERTY INFOORMATION
sing ADDRESS "I14-S v 2 e " /-iJ ENS E �yJ Ci idT`-( SUITE/UNIT 1t
ASSESSORS TAX/PARCEL# 0 ciZ 1 //��0 '4- -t r LOT SIZE(si 52,7 041-
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) t�'TT
i\ C 1 t✓�
Math seperatemx. legal descrlpgag
■ PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING 0 MECHANICAL
N DEMOLUTION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
1:)e - 1T(�� OF C ,1STIr.ILl 4- Gtts i- 31,1tL�iti
PROJECT NAME(Name of Business or Owner Last Name) \10-1-K ES P .A Al Z tai
PEOPLE INFORMATION
PROPEERITYNAME PRIMARY PHONE
OWNER ® N e J0 (20,x) 4(61 - 4sSC,
MAILING ADDRESS CITY.STATE.ZIP
343f>o 5 L4 .5 •66.7r-L6 (.1, 9€1c
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
F7LdCK[a`w00...\ U€P*?-I L q.1.17%(3. -Tv_2-(� C4.4f i A\\ (42-S) 4(oZ - (`32E,
G ADD CDT.STATE.ZIP CELL PHONE
O aX 4�bCcm
13 .E4Lk E ". A g0/5- (4--vs) 5;3 - 2-333
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2 c� —_O (v— t () 2 2 6 -$ k 31 / 0 (4z5)44,2 - c4e
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CM.STATE.ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent (Other(Describe) (T Zc (Z
CONTAC j' PRIMARY PRONE E-MAILADDRESS
E 4-( 1 tC.LI1 - (426 ) a - 316, TEcEP/e 8uctriciAIAI 4c-.
LENDER l'1` ,4 T! p , �, NAME
MAILING ADDRESS an.STATE,ZIP PHONE
( )
I DETAILED BUILDING INFORMATION
=STING USE L T' L AA ( I.Y1 IZ-Z PROPOSED USE
CSO
EXISTING ASSESSED/APPRAISED VALUE $ 60, oC-)v VALUE OF PROPOSED WORK $
SPRI K FRED BUILDING? 0 YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑NO
WATER SERVICE PROVIDER U LABEHAVEN ❑HIGHL1 NE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER St LAKEHAVEN ❑HIGHLINE ❑PRIVATE(SEPTIC)
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION • EXISTING PROPOSED TOTAL
S9.FT. SA.FT. SG,FT.
BASEMENT
FIRST
I-11
17 , E
SECOND ' i ..LS 7
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT 0
•f-- iOlYi¢ ✓
l0�L�ll[Q� c „�� _
} s'
NUMBER OF FLOORS e7
”•NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type ofjiamtre to be Installed or relocated as part of this project Do not Include existing fixtures to remain
MECHANICAL
Willie of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Cuoamnt.° WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMB/NG
BATHTUBS(or'rub/Shower ower comb,) SHOWERS WATER CLOSETS(1MIep MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Salina=wo� VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I cert(jy under penalty of perjury that the lnJbr motion furnished by rite is true and correct to the best of my knowledge,and further,that I
am authorised by the owner of the above premises to perforin the work for which the permit application Is made. I further agree to hold
harmless the City of ederal Way as to any claim(including casts,expenses,and attorneys•fees incurred to the investigation and defense qj
such claim),which may be made by aryl person.including the undersigned.and filed against the city of Federal Way,but only where such claim
arises out of the reliance of the city,including its officers and employees,upon the accuracy of the Information supplied to the city as a part of
this application. l
NAME/TITLE DATE /1,0_,/ O
(Signa ('Nuel
RELATIONSHIP TO PROJECT ❑Owner ❑Agent )(Contractor a Architect 0 Other
YES '�� � C7:a1nr C3 Ill'O
*Nth*. t ,ONLYi+t ......3, CHANGEOI)' 7 c'YES o I)<O
lr �? as YES a� IO. UP A/SU4 3 e"YES ONO
I. .AT`1 ?.Q• T? a;RES a NO:: �\ . ..' . , DEI a, tED? urs a 6 YQ
Bulletin#100-January 7,2005 Page 2 of 4 k�Ilandouts�Pennit Application
• 0
- ` DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8th Avenue South
Aiiii
PO Box 9718
CITY OF Pmullikenwil Federal Way WA 98063-9718
Fe d e ra I Way 253-835-2607;Fax 253-835-2609
www.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.kSBESTOS ABATEMENT 6.ELECTRICITY
(Copy'of approv I form and as tos survey fro Pug t Sound Clean Air (Electricity to be shut off and meter removed) .
Agencyjpro •
t a (� (Puget Sound Energy)
l..-<„'.. City of Federal AT*Building da)
2.GAS SUPPLY 7.FUEL STORAGE TANKS
(Gas to be shut off,meter removed and final bill paid) (Above or below grade fuel tanks,have been pumped or removed
under Fire Department permit prior to any dismantle/excavation)
(Puget Sound Energy)
(Federal Way Fre District#39)
3.SEPTIC SYSTEM 8.WATER-P . ie Source (Check applicable box)
(Tank to be removed or tank to be drained and filled) o r to be mo ed and final -lity bill paid
rtor: a be pro ` 0t7 / ,�
(King County Environmental Services) ater Supplier) •
******OR******
4.SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box)
o Sewer line ca..-d at props-`" line o Private well filled and capped
o Existing t e%t. r-:,Y' .1,,..P.• i-d b ... ed n o Private well to be used for other purposes
(Sewer District) `I (King County Environmental Services)
5.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 $63.50
2.Automation Fee 5.00
3.WA State Surcharge 4.50
4.Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspection)
$573.00
Bulletin#122—March 9,2005 Page 1 of 1 k:'Handouts\Demolition Permit Requirements
Tonkin/110ne/Lokan •
Architecture&Urban Design
Community Development Services
City of Federal Way
Re: Legal Description
Building Permit Application
Villa Esperanza
31458 28th Avenue South, file#04-104537-000-00-PC,#05-106296-00-UP,
#05-106197-00-SE
Legal Description: THAT PORTION OF THE SOUTH QUARTER OF THE
NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 9,
TOWNSHIP 21 NORTH ,RANGE 4 EAST,W.M. IN KING COUNTY
WASHINGTON, LYING WEST OF PRIMARY STATE HIGHWAY NUMBER 1:
EXCEPT THE WEST 30 FEET THEREOF.
204 First Avenue South Seattle,WA 98104 206-624-7880 fax: 206-622-1766
07-31-2006 11:20 From-SKING • +2534376711 1-635 P.001/001 F-238
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8th Avenue South
CITY OF __ -•••
PO Bax 9718
Federal Wa Federal Way WA 98063-9718
253-535-2607;Fax 253-835-2609
www_ci vof fedzraKway.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),
Nome;To.trriiCAN ; Utilities shall be disconnected and services performed.if applicable.prior to issuance of the demolition permit.All applicable
items below are to be Aigliaand dated by the respective agency representatives.
1.ASBESTOS ABATEMENT 6.ELECTRICITY
(Copy of approval form and asbestos survey from Puget Sound Dean Air (Electricity to be shut off and meter removed)
Agency provided)
Puget Sound Energy
(City of Federal Way Building Official)
2.GAS SUPPLY 7.FUEL STORAGE TANKS
(Gas • . ', ut e m and I bio pa'
�flet, (Above or below grade fuel tanks,have been pumped or removed
G+ Vigo/ under Fire Department permit prior to any dismantle/excavation)
(Puget Soundinergy)
Federal Way Fre District#39)
3.SEPTIC SYSTEM B.WATER-Public Source (Check applicable box)
(Tank to be removed or tank to be drained and filled) a Meter to be removed and final utility bill paid
o Meter to remain and be protected
(King County Environmental Services) (Water supplier) "---
s*****OR******
4.SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box)
o Sewer line capped at property line a Private well filled and capped
o Existing sewer line to remain and be used by proposed new sb•ucture o Private well to be used for other purposes
(sewer Di ti ICt
(King County Environmental SerMceSr -
5.GARBAGE
(M household garbage disposed off and final bill paid)
(RST Dlsposal/federal IivaY Disposal) .
❑Completed Construction Permit Application form
❑Provide the following fees: 1.Demolition Permit Fee $6350
2.Automation Fee 5.00
3.WA State Surcharge 4.50
4.Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspect1on)
$573.00
Bulletin*122-March 9.2005 Page 1 of 1 kltlandauts\Demoliuoe Permit Requirements
JUL-28-2006 00:19 P.
• LMUL,INL411
PAGE ,li2l'8
ail/// •
n#1'1e',S II,s,^y�91Nfy'
'Ve
DsPARTML1 T or COMMurr . :, "r's
rtT'7dJ4'%�`� �rr:! �Ydl�' ' "i pdki" r;
CITY OF r' #8 '' '''' ' � y"k. '„+
11
1 1x1i91*Fai: _;71.4609. °:”' I. Y
Federal253.:33,. ,r ' ,�_ 4:',
•
DEMOLITION PERMIT REQUIREMENTS
A demolition pcmoit is Required to remove any sttuctem or structures on a subject ;;';' =
seeif the proposal exceeds olds that tri environmental
xe ie rid'Check w tnwt + ing;°`' " "r a'
Divisionto „ ;
tliresb trigger a�envirorurrcntal tcvxew,An ctivironalCrat�al' ' , -,I�"���•t;, :'��:',
submitral of an environmental checklist may be requited,which wail,extend the time od before ,t o r
be issued. peu a de.�iNTieic+la; #eui
• ,',f'n�`i•Iris,
•
r to �'
CI Prix submitting a demolition permit,the following items(as applicable)must be • •”' ;,, f f • ;h
agency(pee attached Demolition Permit Contact Litt). ► e """ ',';N i° t=''1'
No�'msrrucan+r: t3Hlsti'fesahallbedf ' ;� '' •, '��'�: ;,,�,, <
ecwnteeMd and services perfornt�if p t issuance the dare
items below are to be ed da prior b rs Rf ldforrpmliilritll (Cable.;
signed F rrdblr the respective agar�y repre�erilarlvr.
1.ASBESTOS ABATEMENT S.ELECTRICITY :1;ti : 11014"a'
(Copy of approval form and esbestos from
Agency provided)
Puget Sound Clem Air (Qecplvity to be shut off and meter removed) d6'
G 6f r4oa&Way (PU :'x,' +y};,`,,j,
( rY Ow. atidaq _ �•I 1y
�.GAS SUPPLYSTORAGE TANKS
ntebr removed and foul Ulf 7.FUEL i
(Gas be shut , l ,5 • ,i
(Atone or below grade fuel tanks,have tteen pe�y 04
under Fre Department permit prior to any diernen11e/'
Baer Sound Energy) )' ` '4hj ';
1:11512
3.Sil;PlriC SYSTEM '. .��������'
(Tank t4 be removed tank to drained B.WATER-Public Source (Check epalrtable'box,)` '' '; •
;F{ ,'
be rued and filled) a
Meter W be iMmravcy and final utility bill paid ,�y �;' rg
C Meter to remain and be protected i f.r„ , _,
t ►q co fl E—rWkonm4n�Ser ce5)
4.SANITARY SEINER (Check applicable box) S.WATER ' ''7"
c Sewer tine capped et property Nie 'Private Well(check sppltcarble box) `('` ,
Erlsdn server llrb o Private well filled and capped n ' r•.,
9 to Tamale and be used by proposed new stnrtb,u+e o Private well to be used far other purposes ' '
(Sewer Dist I (An9 COunty ent8)
5.GARBAGE ' '
(AN hauseltiotd garbage dlspoeed off and time bl paid) .t c ' {'
ttL
,340
(izSr hoose(F ay D I) ±
Cl Completed Censtruc'hion Permit Application form
0 Provide the fbllo •
• ,
wiug Rees: 1.Demolition Permit Foe~ $63.50 • �''t'
2.Automation Fee 5.0x1 ,
3.WA State Surcharge 4.50 ''; ;
4.Cash gond Deposit 5 n �.�.y .::;;•e;:'
$573.00 �eRpG1"""��.-..... I' )f � �
dig
:url `� Mn 9,1l O - �-. 7'14;4?+
Peke I of 1 k:ariedboloMdnolition `
Parndl'R�rj "4nonte ,q'. .I. x', I"
"4].' 'i%
TOTAL P.03
07-28-2006 12:09 From-SKING +2534376711 1-630 P.002/002 F-215
•
•
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 Ri°Avenue South
/� PO Box 9718
CITY OF t (ZS l�C Fedcrul Way W A 98063-9718
Federal Way t 253-535.2607:Fax x-835-2609
www_ci offcdcrai va .cos
I ,
DEMOLITION PERMIT REQUIREMENTS
A demolition pemait is required to remove any structure or shucwres 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 envuanmevrei checklist may be required,which will extend the time period before a demolition permit can
be issued.
Q
Prior to submitting a demolition permit,the following items(as applicable)must be signed by the respective
agency(see attached Demolition Permit Contact List).
Nair mArr.uceJr ua ities.Jwll be disconnected and servikeepofonaed if appLcablA prior to isfiwwice of the demolition pew All applicable
ire=below are to beammignAdegiAby the respective agency representatives.
*.ASBESTOS ABATEMENT
6.E
(Carly of
Papwoval form and esbesws survey from Puget Sound Gann Air • a 1� t4
(Puget SoundEnergy)
(Qty of Weal Way 9ulkllng Otto*
2.GAS SUPPLY 7.Fun.STORAGE TANKS
(Gas to be shut off,meta-removed and final bill paid) (Above or below grade fuel tanks,have been pumped or removed
under Ree Department permit prior to any dsnnantie/ei ea atian)
(Puget Sound Energy
(Federal-Way Fire pint.39)
3.SEPTIC SYSTEM 8.WATER-Pubhs Source (Check applicable box)
Crank to be removed or lark to be drained and filled) o Mem to to removed and final Wilily bill paid
o Meeer to remain and be proms
(lOng Canty Emriranmen*al S (water stWleil
was.OR was=
4.SANITARY SEWER (Check applicable box) S.WATER-Private Well(Check applicable box)
13 Sewer line capped at property line a Prhrate well filled and capped
a Existing sewer line to remain and be used by pmprred new Stu:turn o Private well to be used liar other pub
(Sewer[Wrist) (King County Environmental Service$)
5.GARBAGE
(AU household garbage V1I T e1'strand al bill paid)
(JT Way Disposal)
O Completed Construction Permit Application form
O Provide the following fees: 1.Demolition Permit Fee $63.50
2.Automation Fee 5.00
3.WA.State Surcharge 450
4.Cash Bond Deposit SOROS (Reloadably open Comdata Final )
$513.00
Merin*122-March 9,2005 Page 1 al lemwdowsiDemolitiou PamirRequirements
,/27/2006 13:58 FAX 206 689 4073 PS CLEAN AIR LI001/001
1.:7/25_/2_0_917:21 20645.1 COMMON GROUND . FACat. i:Jv U
200602 72t4
Agency Case No. PUGET SOUND CLEAN AM Date Received
d V ,'• .�. -,e.:•• oEUnion Street,Suite 500 �'S A I R I ,� �)
0t t ''r:,:. : .1r,;:;,.y to scot! WA WA 98101•x038
WWW.pscleafair•org
Aserky irge " -_- NOTICE OF INTENT i rex v Only
.. 61.1..0, ,\.IL. _. 0 ' 1 Y ii _ L+r.4- i HI gay . m Li.a: ..L Z. 1...-11.,. :__y.U., 1 • 1,.9 i.L• 11 ._ A . aliioJ •. J
R.
Property Owners V t"144 Zeissirace r 4 4 L 4 e )Phone: 2d •'a'0I-°/%t41)
iylalli�g,$ ess: 3 FD 1 S, 'di/r%4 .. city:fid " fds" Safe Solvf zip:411llI
C. Asbestos .u.err41srazimut nils aararae REL
Contractor: 1'e Lk'2E C' 0 r- �f_ lit) A Owner EO: M _
C01itCaCtor
Yelling Address: '513k SE 'C..e i•~aTc-Q— 3 f phone. 425—861-6777 Job No.:
,: Snk,0uA 1_1-Al r~ auto: GV A --zSoC.S pize Q'2 s 1— eel•- - F2-7-1
D. Site
Address: ,1`!Cf" ,2 F *E "lot C.24.4 c e l 44).47 zing 9Face
site
Manager: i.. r a4.4.h.4,_ ;ec.4g &ie Phone c 10+:• /A 2-I?•n i
E. 1af Asbestos Survr No.of -�-Date of As ✓'''f 4- Was Friable Asbestos Identified? UYs Ilio
O l t'l Preasesroed Stratus cq: I Sw vev: _$i I. 'n`!r Was Nonfriebks Asbestos lde nti5ed? Wes LINA
AHERA Building / (�. C gmbon,h1i; /E/ae At aeh a ever of thea Ivey when/144k asbestos
inspector �n l w rl+ .•.pug Z // a hal rrai"been identified
'Ss t 5ia*vrereadredbefore all da allifeepra e
F.F.Demelit tori Start It.- o c No.of 1, u Training Fire(List F1re Dept.) —'
information: Date: • •' -d: ' szr .1 2.❑ Demolition(attach copy'of L
'Demolition dononrim t riftraderrm m back1W"1 nonf'inble asbestos be left in place during demo?ties M No
Res o w .pm. .1 cc,41- Y+at,list type and qty. Neta disposal requirements in Step 6(on back).
G. Friable At brtos I Work Days: M T W Th F Sa Su
prof eat Imo: Start Date: Comsletian N How
Will all ftlable asbestos CI Yea
Total Sty.to be Removed: Linter Ft. --,� Ft bo D N
LI Bol eekria see Insolation U Duct Inaulstian LI Pipe Insulation U Irtignootiin Pointe Plaster Texhaed Coatfegs
Cemcnr Head Cement Pipe U Friable Flooring Ll Fable Rvoling.smaiiial Orbe:
EL Asbestos/Demolition Project Cir Notifketitto kind Project Demolition
1. Slogle.Fassely Residence(ow •oeeupled): F.g$ MAIM
A.ate lentos Removal Only A.Prior Notice A. $25
B. TV Demolition Project(with or admit asbestos removal peuject) 8.10 Days" H. $50
'Asbestos removal can ban ii. notiSi- •derlol•+•....,,- .tvat 10 -- -- -
Nnte:Ifthe single/angry residence is owned by one,family who hos been or will be wring the residence me Their domicile,the above boxes
IA or 11)may be checked Ifthis it not on owner-occupied residence,este ofthe categoric:fisted below trust be used Weed A single
_Toed
does net Inelnde rental property,multi'-foully or or y mined-ase btNdln;. ...
2. Alt Other Demolitions(with no Asbestos temoval or Nonfiable Asbestos 10 Days $100
only or less than 10 lour feet and/or 4$ •wire tint of friable Asbestos
l?Mable Asbestos Projects(odter than Single Pare$y Residence); Asbestos --- .. Dana
3. U z 411 Prior Notice 10 DUYs_. 9:100 _ $100
4. UR 260-9O linear tree and/or 160-6999 square feet of asbestos . 10 Diva $200 S100
5. >1000 linear whet and/or 7S are feet of asbestos 10 Days - $600 $100
6. EmerSenc7 Asbestos Pnject or Emergency Demolition Project PriorNotee $90 Emergency Pee
•n - .••. Residences W edam• Oom- -,;,ice eta heitevtp• . 'a.c3 awhseesmteat• • 'de written-. ^. --•.",i
•
1. t minify that the itdammcon attained is this nebFiertica ae=miasmal dein 4i,to the bet either kri]wledge,accurate a err plea. ,A_ ' , ..0*
Puget Sesta Clean Air Apenmy Form No.:66.161(Revised VMS)TS M �tJ d
AMOUNT //JJ �'
CK, NO. rl !; 1a .81 Co
RCPT.Jl1O. R C3-
.3-