01-101206 S
4 City of Federal Way Demolition Permit #:01 - 101206- 00 = DE
Comr ;vy Development Services
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: ROSEWOOD LANE
Project Address: 36107 6TH SW Parcel Number: 302104 9039
Project Description: DEMO-Demolition of existing residence for future construction of a 9 lot single family subdivision
Owner Applicant Contractor
9280 PARTNERS,LLC C/O NOVASTAR DEV 9280 PARTNERS,LLC C/O NOVASTAR DEV THOMAS CONSTRUCTION CO
18215 72ND AVE S 18215 72ND AVE S 18215 72ND AVE S
KENT WA 98032 KENT WA 98032 KENT WA 98032
(425)432-8450
PERMIT EXPIRES September 25,2001,IF NO WORK IS STARTED.
Permit issued on March 29,2001
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.
O
Owner or agent: 4'/.//// Xv7-^,, / Date: ��/��"i'�//l `/
y , \.).)
rre
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7117fGC CONSTR ON PERMIT APPLICATION
uV may — APPLICATION NUMBER: O l - I d 2 O _�
MAR 2 q 21)01, APPLICATION NUMBER: 61 L . 1 ZQ q _
APPLICATION NUMBER: -
-
LA 1Y OF FEDERAL WAY
**The followingg0i 9 anmation—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.-
■ PROPERTY INFORMATION
98023
SITE ADDRESS: 1fi107 6th Ave SW Federal Way, WA ASSESSOR'S TAX/PARCEL#:. 3 0 2 1 0 4 - 9 0 3 9
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): The South 1/2 of the NW 1/
of the NW 1/4 of the SE 1/4 of Section 30, Township 21N, Range 4 E,_ W.M., except the East
30 feet for road, in King County
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING ❑ PLUMBING 0 MECHANICAL I DEMOLITION
0 ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): Demolition of existing (vacated) residence for
future construction of a 9 Lot single family subdivision.
PROJECT NAME: Rosewood Lane
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
9280 Partners, LLC Lam (,k 101546- 07-T (425 )251 - 6110 ' L
MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
18215 72nd Ave South Kent, WA 98032
CONTRACTOR: NAME:
Thomas Construction Company Inc. DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): (425 ) - 8450
EVENING PHONE:
18215 72nd Ave South Kent, WA
CITY OF FEDERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
- 4015 - (425 )432 - 8457
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) 1L a M- A S _C 0_ .4 4 R 1 11 / 19 / 01
APPLICANT: NAME:
G. Wayne Potter, Project Manager DAYTIME PHONE:
J g (425 )656 _7435
MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): c/o 9280 Partners, LLC EVENING PHONE: ?
18215 72nd Ave South Kent, WA 98032 (206 )972 - 2153
RELATIONSHIP TO PROJECT:
FAX NUMBER:
• 0 ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): (425 )251 - 8782
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER I]APPLICANT ❑CONTRACTOR ,potter@novastardev.con
■ DETAILED BUILDING INFORMATION
EXISTING USE: Vacant EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ $55 000.00
PROPOSED USE: N/A PROPOSED VALUATION FOR IMPROVEMENTS: $ N/A
SPRINKLERED BUILDING? 0 YES I NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: 'ji LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ® PRIVATE(SEPTIC)
• •
**NEW RESIDENTIAL CONSTRUCTION ONLY** N/A
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
A AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
it
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
.:' ■ DISCLAIMER/SIGNATURE BLOCK .
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 defens• of such claim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only :re such claim arises out of the - ance of the city,including its officers and employees,upon the accuracy
of the information sup. •. tthe city as a part of this -.• ca "on.
NAME/TITLE:
j /
lrVd/,/ DATE: March 28, 2001
naTije' .-.'
❑ PROPERTY OW R" ® APPLICA ❑ CO RACTOR
FOR OFFICE USE ONLY:
0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR .0 TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? 0 YES 0 NO
COMP PLAN DESIGNATION BASIC PLAN? ❑YES 0 NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? 0 YES 0 NO
PLATTED LOT? DYES 0 NO CHANGE OF USE? 0 YES 0 NO
COMMUNITY DEVELOPMENT SERVICES-33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718.253-661-4000•FAX:253-661-4129
DEMOLITION PERMIT APPLICATION Surccharge $ 4.50
CITY OF FEDERAL WAY CAS'BOnd 500.00
BUILDING DIVISION (Person Bond)
33530 First Way South
Federal Way,WA 98003 EC__
(253)661-4000-Fax(253)661-4129
MAR 2 9 20 r!
DESCRIPTION OF WORK
LA i Y OF FEDERAL WAY
RI III DIN;;nEa7.
PRIOR TO APPLICATION
NOTE:I understand that the following utilities shall be disconnected and services performed if applicable,prior to issuance of the demolition permit.
All items are to be signed by the respective agency.
1. ASBESTOS REMOVAL fl. GARBAGE
(see attached) ??V1 N/A
(Building Official)
ELECTRICITY SEPTIC TANK PUMPED AND FILLED WITH CRUSHED ROCK OR
REMOVED/OR SEWER LINE PLUGGED AT PROPERTY LINE.(Inspection
(see attached) required prior to backfilling).
(Puget Power)
addlbd
TELEPHONE ,! WATER LINE CUT AT PROPERTY LINE(well capped).Inspection required
prior to backfilling.
(see attached)
(US West) (see attached)
A GAS X ALL UNDERGROUND TANKS PUMPED AND REMOVED UNDER FIRE
(see attached) DEPARTMENT PERMIT PRIOR TO EXCAVATION.
(Washington Natural Gas) N/A
,WATER-DISCONNECT REQUEST IA DELINQUENT UTILITY CHARGES PAID
N/A N/A
INFORMATION FOR APPLICATION
JOB ADDRESS 36107 6th Ave SW Federal Way, WA 98023
ThwnS hip/2 1 off,thranNW 4/ ,oA.1he eNe4 tif eae t SE30 1 eeto secnn3
ling CountyLEGAL DESCRIPTION
TAX PARCEL NO 302104903901 (Attach if lengthy.)
OWNER 9280 Partners, LLC
ADDRESS 18215 72nd Avenue South Kent, WA 98032
CONTRACTOR Thomas Construction
ADDRESS 18215 72nd Ave South Kent, WA 98032
CONTRACTOR'S LICENSE THOMACCO44RF
req.' 11-19-01
EXP
„At A7 ft
Signature pplicant Ph e
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02/27/2001 14:31 2535824041 NWABATEMENT PAGE 02
02/27/2001 14:14 FAX 425 261 ly BARGHAUSEN • X002
DEMOLITION PERMIT APPLICATION n"�. :_ .._.
aso
CITY OF FEDERAL, WAY -, 500.00
BUILDING DIVISION
33590 Vint Way South --
(asa) adua1 Way,
AA,s9 003 MAR 2 9 I
Qt t Y OF frLDt:i AL tiff;F'
BUILDING DEPT.
Dr.sawrium OP WORK
....
PRIOR TO APPLCATOOM
NOM i urulirararrd dbg daefallorbig r MI&Ad be dlacomwend and srr leaspe►,lbnNad V appikablrAprior.to unmet Ode densolidal Pamta
All ftnr►,'err b 8e signird by dm rmpeciire Ammo,
•
1. 31413331W: 6. C+u.bff
gado/ _ tlJ i li
2. Etsai*ticrr•r.- -
7. SErrw TANK TIMPED AND FELLED WUK cauarucp aocLaa
REM ssw ..1... rrvccr,D'TPROMTyL12N.(Inepactton
r+�9udOat. backBulna
3. 7u.arncork 7- 8. {t1AMEtr.m
CUT ATFAOT8RTYLIM(wolf upped).Iturection regr;oaf
prior to bukdilling.
([13 Well)
9. ALL vr aROUX0Tnt s PUMP=AIVRID,EVIDUNbisArrns
DMPAtk3118KPBIWtTFRIORToF?tC1A•VATIoN. _
5, Wxtine.11000lttttarxtBciC7gas •
10. DRielsrifaarnr Cts Pam
•
INFORMATION P�APPuCAT1ON r �•
Jae ADDAMS ^'11 1 07 -�`144%`ave, 5.tA) • ` - a1,e,,e. r •
MC Saye do-, i.al� 04 14%t &MA wt4'f cermet w ' .PCS ,r Co
L3GALD�r ..,, r f P I,, - . $ t I.dA. u'O B..1rr Col.
3TaxPa No Pes•1-• 3o :e- r r• s1C'dacl ,_�, 1 n� 4,.i rt 1 I nn 5-.4"--' "('1
�,,y�ye • 7 S Mk ifla►gthy.)
( Ammo.12 .M.1‘.4&_,L._al -z.Lth______ke. Y,::::.? -_
A00618a3.,_ .
s Liam OcmYtare ��„..
EsanurroN Dwta
Sisaange ofApplioant
na,, ,, F'honc
,,
MAR. -01' 01 (THU) 13:48 PUGET SOUND ENERGY KENT TEL:253 395 6835 P. 002
uz/z778.
/2001 14:49 FAX 425 .251, 2 BARGHAUSEN
• 1002/002
„s-c c,.=„
r Demo Permit Fee
DEMOLITION PERMIT A , sinr.huse Oso
CITY OF FEDERAL WAY Cash Saud soo.00
(Porno Paying Board)
BUILDING DIVISION Fuum+ k c
33530 First Way South -
Fodetat Way,WA 9S003
(253)661-4000-Fax(2.53)661-41124
DESCRIPTION OF WORK
PRIOR TO APPLICATION
NOTE;I understand that the following utilities shall be disconnected and services performed(f applicable,prior to issuance of the demolition permit
All iters arc 0 be signed by the respective agency.
1. AsEssras Rea tovAL 6. GARBAGE
(Building Official)
2. ELECTRICITY 7. Se=rer TANK PUMPED AND FELLED WITH CRUSHED ROCK.OR
Fr 1-‘44:
`-}; REMOVED/OR SEWER LINE PLUGGED AT PROPERTY LII .(Inspection
requited prior to backbiting).
Live_
7 u et Power) !�►/ 1 l
. A
3. TELEPHONE • 8. WATERLxcUTA7PROPERTY LIM(well capped),InspecLanrequired
prior to backfilling.
(US West)
4._(IAs 9. ALL UNDERGROUND TANKS PUKED AND REMOVED UNDER P181
M
DEPARTMENT PERMIT PRIOR TO EXCAVATION t3 646
ington Naturn�l//pq)
5. WATER DIS REQUEST `T 'r ®' 10. DEUNQUBNT UnLrry CHAMOIS PAID
INFORMATION FOR APPLICATION
7aaADDREss 36107 6th Ave SW Federal Way, WA 98023
The outs half o t e no these arse ofzthe northwest f
southeast quarter_o. orrn o�adq on i`n (oungvg range q�iaeas ,°G
LEGALDEsourrrON excepttie eas >;��
TAX PARCEL NO 302104903901
(Attach iflcngLiy.)
OWNER_ . 9280 Partners, LLC
ADDRESS 18215 72nd Avenue South Kent, WA 98032
CONTRACTOR -
ADDREss
Cot rrs+Actotc's LiesNSE
(cow fcg'd:1
EXPIRATION t)ATE
Signature of Applicant Phone
Dehourtmp
tlunag,SAVA
Mar-06-01 10:18 From-py7003344 + T-782 P.001/001 F-416
02/27/2000. 15:39 FAX 425 251 8741, BARGHAT.TSEN
DEMOLITION PERMIT APPLICATION sim*Pcn2"3e6 - S 4.50
CITY OF FEDERAL WAY -oish Band 500.00
(Person Payiv Bond)
BUILDING DIVISION
33530 First Way Souris
Federal Way,WA 98003 -
(253)661-4000-Pau(253)661-4129 MAR 2 g 2flfl
DEaCRIPTION of WORK -
PRIOR TO APPLICATION
NO3 l understand that thefallowtag vff!'$cxliolt be disconnected and services performoa ifapplicable,prior to irastance ofto danolaion permit
All rams arc/a be signed by&rival:M agency. -
L .AB8Sro3ivAL 6. GARSAc3a
cBu1cling Official)
2. EtucroicrrY 9 SuPTIC TANKIN VED AxoEnizu VJI H clOOSTIED Itxx alt
.rismovac ort SEIM.LINE PLUGGED ATPROFIt1YLINE.(InnSpcct ari
(hut Power) required
prior to backfilling).
3- Tuata . - S. WAR°LDCBCUTATI: ML'RrTUNS(wencappcd)-Inapodi=r°equiz.d
. ` e prior to bsak5lling,
(US We f3
�. 0.1.1 9_ ALL UII 3ND 'PO[dE8DZZFMay=TIMER FMB.
1:11PAIMOTTPE1WITPR'IORTOBKCAVainoN.
(Washington Natural Gas)
S. WA2rEa-Dlseomucri Egc,2sT 10. rUi�u'YCa sEn o
• INFORMATION FOR APPLICATION
ionADDsE= 36107 6th Ave SW Federal Way, WAA 98023 rr��
Rgio_st ha�,f of gte -ao thWei& q arta of �'zesg2Eit nga9 'aeasE,Q4.I�e
quare o sec ivu o '
7.srtar.7rscRlrtsosr ; -u= . _ e _ a • _ rag: n- ou. y.
F .Q 302104903901 ..- hiflengthy.)
Ow — .9280 Par caers, LLC
NERAntes 18215 72-nd Avenue South Rent, WA 98032
CoNTRALWR
•
ADDRESS
ComalAcToR's LLCM
Pr).srq a?
EXPIRATION Dias
Signature at-Applicant Phi
m
MAR-28-01 WED 09:41 AM EASTGATE ENVIRON. HEALTH FAX NO. 60946 P. 02
09/26/2001 11:30 FAX 425 251 /IfBARGHAUSEN4111 X1009
,Y0 cro
DEMOLITION PERMIT APPLICATION °�o `'�°°�
aso
CITY OF FEDERAL,WAY _ 11411d soo.eo
Mottos Pt)*
BUILDING DIVISION Rood)
33530 Trot Way South 51, +trx$xt. IN 1►
�ale�Wim,VA 98003, f _
(213)6d1,-4O0O-Fax C253)661-4129
MAR 24 2i
DESCRIPTION OF WORK. Liu r yr u 6 tai vvrtV'
5UIwmQ-DEFT.
PRIOR TO APPLICATION
NOTI wwd atand that D,r jallawu g uti ilia shall be discam:ccird oldso►+orspaformed L flopplaable prior to&ma a cfrthe demolition permit
All do rr aft le br dgprd&y thi PMspdct>t a cgunc t
1_ AusitvAL 6. Gatmin
(Budding Ofan -- - "-'
F*=^s■arY (�TANK PUMP=AND PU-T= rstuslaD ROCK OR
ORSEWWR LAIPLOWED ATPROPERTY MIR.anapection
(Puget Power) ))-
�n
010-0
3. TiLant rte S. Womanitat A.T paotont.rrznaz(wetttapped). on moiled
p to fig.
(US West)
4' Om 9. AISintoS atto0140TANKSMW MANDREMOVEDUNDERVI
(WailungcouNatural Gas)
5. WATER-DlsOoMsarR>r,QDGST 10. DaLsaQustd'1'Chun CHAS.0112PAM
INFORMATION FOR APPLICATION
.TOs AEU=
124ALDEsemitrriot4
TAx PAriCSL NO ,_(Attach if lengthy.)
OWNEER
CorrrRActOR
Anon
Co:tYw croR'sLtmrrsa
IrxKIATION nATR
Signature of Applicant Phone
asiounAgg
> xtv"
FEB-27-2001 TUE 03: 19 PM LAKEHAVEN UTILITY DIST FAX NO, 253 839 9738 P. 02
02/27/2001 18:06 FAX 425 251 87� BARGRAUSEN • I¢�002
VDemo Paul Fos i
DEMOLITION PERMIT APPLICATION ilindiarge 4Cus )
CITY OF FEDERAL WAY s soo ao
BUILDING DIVISION ;, , psi ----
33530 Fast Way South
Federal Way,WA 96003
(253)661-4000•Pax(253)6614129 (
t:I 1 Y OFw
BUILDINGDEPT.
EPT;
DESCRIPTION OF WORK-
•
-..- ._
Num TO APPLICATION
NOTP.`Understand that drejoAevehig utilities shell be diWcarnnec ed and mardeesprrformed,ifunlikable,prior io issuance ofrfisdedfoliden Perna
411 items ere to be.sigred by the rrspe:live ggerfv.
1- Asnaat+osREMOVAL, _ 6. GARB
OUap
2. $sc'[AUctr a • 7 SSrrtc TAM FOAM A1ZPFM=WITH CRIJMSD ROCK ASL
82740v110/01;21Rnat t.AIE PLUMED AT PilkeERTY UAL(Insp xtinn
Etcivacd Friar pa backfilling).
(Raga Power)
3. TELEPRoRs 8. WAMLDIScar ATPauwwSKTYY (Writ cappod),I'Rspcctioa rcgoired
prior to,Warms.
Wed) //, • tm/- s / �Il�.r' ..1 1G4_2 !
4. GAB 9. AL1.131=RGROCINDT11=P0/41AAta3VEMOvED • lax&.
(Washhsgtosr Natrual Gas)
S. We�T a-DISCOMBCrE r 10tIlw3rrh trYtff.4a ssPAID
•
•
INFORMATION FOR APPLICATION •
JCA 36107 6th Ave SW Federal Way, WA 98023 }�
e fl°° 'ea a: e ° R �adq � c range4 'eeati,° .#e
La:ALD> TION ARM ,l,l() eie
TAXPAacELNo_ 302104903901 •trach iflangthy.)
9280 Partners, LLC
Oars i
ADDRESS 18215 d Avenue South Kett, 'WA 98032
COt(rL CTOR
CoxrB Croe alacBZ$E
ttorrf•I
RATIONDA1
Sigpatwe of Applicant Phone
mammon
11/06/20001 10:55 2535824041 NWABATEMENT PAGE 01
•O6. 6I - '1o7341)
Agency Caro No. .PUGET SOUND CLEAN AIR AGENCY Date Received
0.0
Q Q 8 110 Union Street,Suite 500,Seattle,WA 96101-2038
2 ".- w ' fl OF INTENT1:_ _' [AIR �I !� 2000
i 1
Agency Ilse TO PERFORM: r k w Allem"'U�Only
MAR A ?II
�wA. Proect T r.. , 1.0 Asbestos Removal 2.■ Abeam Removal&Demo 13.0 Demaudo ' for Re moval{ e -f 0..:.4.14 WAY NON) 4 LUUJ• B. �Per4 BUILDING DEPT.
Owner: Nova/nort Phone:(a25 ) 656-7401
Mailing Address: 18215 72"Averme South , Com': WA Zip: 98032
C. PLUMP*+rcwur.reas.n,cesmraeerw I(dL ouasc. Contractor
Contractor: NW ABATEMENT SERVICES,INC. Owner/CEO: TONY BETZ
Contractor
Me ling,Address: P.O.BOX 39246 Phone: (253) 588-0/40 Job No.:
City: LAKEWOOD State: WA Zip: 98439 Fax: (253 ) $86-0198 821-00
D. Site
Address: 36107 6r Avenue SW City: Federal Wa State: WA I Zip: 98023
Project Manager or
Contact Person: Ken Belt Phone:( 253 ) 588-0440
U. ■ Asbestos Survey or ' No.of Saucwrea: Date Survey was Was Asbestos Found? Wes
0 Mat'l Presumed: 3 Conducted: 10/18/00 0 If No.Attach Survey
ABERA Building AwAMA suRar ISAMUSED WOW AMeeMOIMON rNAIsas Expirafion
Inspector Name: David Swanson Certification No.: 3509.00-C111-01 Date:9/1/01
F. Demolition No.of Stan 0 Training Fire(List Fire Dept.as demolition comuaetorbelow)
Information: St uctntes: 3 Dmf 03/01/2001 _ 0 Ordered Demolition(attach copy of Order)
Demolition PiDff NOE WM NITIMIAILINCIDDAMMIOX JON JACK.IF MOPING$UJNsera slU Den inots
Contractor: Thomas Construction Company.Inc. Phone:( 425) 432-8450 .
G Asbestos Project No.of Structures:(see Start Completion Wt.Days: M T W Th F Sa Su • .
Information: beck if>1) 1 Date: 11/7/00 Date: 11/10/00 Houn: 8:00—4:30
Will all asbestos material be removed by ■Yea
Total Quantity to be Remov d: Linea Ft. SO Square Ft. project completion? 0 No
Thermal System Insulation I 0 Boiler Purace Its: 0 Duct Ins. 0 Pipe Ins. Other: _
Surfacing Mail. [O Fireproofing 0 Paints O Plaster 0 Textured Coatings Other:
Misc.Mat'l: I 0 Cement Bd. 0 Cement Pipe ' ■ Flooring Matti O Roofing Mat'l Other:
• 1L AsbestodDentelltioa Project Categories: Notification W iena Project Fee
1. 0 Own --Occupied Residential Asbestos Removal Project j NON-REFUNDABLE
■ Owner—Occupied Reeidemial Asbestos Removal&Demolition Project
O Owner-Occupied Residential Demolition Project,No Asbestos Removal Prior Notice $25
2. 0 All Other Demolitions With No Asbestos Removal Project 10 Days 5150
3. 0 10-259 linear feet or 48-159 square feet(see back ofform for options) 3 Days 5150
4. 0 260.999 lamer feet or 160.4,999 square feet 10 Days $300
S. 0 1,000.9,999 linear feet or 5,000-49,999 square feet 10 Days 5750
6. 0 10.000.49,999 linear feet or 50,000-99,999 square feet 10 Days 52,000
7. 0 50,000-99,999 linear feat or 100,000.149,999 square feet 10 Days 55,000
8. 0 100,0004-linear feet or 150,000+square feet 10 Days 510,000
9. 0 Emergency Asbestos Project or 0 Emergency Demolition Project Prior Notice Twice Project Fee
10. 0 Alternate Means of Compliance for friable materials or 0 Demolitions 10-Day Review Period Twice Project Fee
11. 0 Alternate Means of Compliance for nonfriable asbestos materials _ Concurrent with Project Twice Project Fee
L I do hereby cat*that the information contained in this notification,and aupplenrenral data described herein, is to the best of my completeness R.
knowledge aotnnta and complete. I shall not cause or allow any asbestos project or demolition activities to begin until the appropriate waiting
period has elapsed. Performed By:
l4
t )... ABATI"s1y NT SERVICES.S/paatu�r NW Representing INC. =rag [till; od
4
pA x+ r , 'gestf: Use err.
PSAPCA Form No.66-160(Revised 10/96)AM u t. -et q `!"
50 -clef
11/06/2000 10:55 2535824041 NWABATEMENT PAGE 02
(PSAPCA)is the local air pollution atity for Snohomish,King,Pierce and
The Puget Sound Air Pollution Control�ncy 'on be submitted to PSAPCA, oa Agency-
Kitsap Counties. PSAPCA's Regulation III, Article 4, requires advance notificatt ter arae than eete10
e to or gree
approved form no. 66-160 (Revised 10/96), for any asbestos project involving materialsgoal
linear feet or to square feet and for any demolition of Intent should be mailed or hanardless of asbestos d dte invot PSAPC�A(address on reverse
mg
roof area greater than 120 square feet. Notices
side)with the appropriate Project fee. A PSAPCA representative will review the notification,and if it is completed correctly a
copy will be mimed
by mail within 3 to 5 days to the mailing address entered is box C and box J. The returned copy will be
your valid notification. Asi�tos andlemoliti2P projects involving "materials and structures below the notification thresholdg
is - 1 � 1 i� 0,1 - . II 71,tso P C - '• •''Q't. 1\10 1 < 2000
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irumavim rocateni,mama Loa
J. Demolition •
Contractor: Thomas Construction Contpanyi Ina Owner/CEO: Tom Barghausen
• • Contractor's
Mailing Address: 18215 72jd Avenue South Phone:( 425) 432-8450 Job#:
City: Kent
I State: WA I Zip: 98032 Fax:(425) 251-8782 NA
GUIDELINES FOR SUBMITTING AN ASBESTOS/DEMOLITION NOTIFICATION
Box A. Check the appropriate project type.
Box B. Enter.the legal property owner information. For Owner-Occupied Residential Removal Projects(category#1)where
the property owner's mailing address differs from the site address,a letter must be submitted explaining why the addresses are
different.
Box C. Enter the asbestos contractor and mailing address or other properly trained company or person performing the
asbestos project. Contact the Washington State Dept. of Labor & Industries or OSHA for worker training/certification
requirements.
Box D. Enter the project site address for the asbestos project or demolition. Include a designated project manager or contact
person.
Box E. Check asbestos survey or material presumed. If asbestos survey is checked,fill out all information requested. All
danolition with or without an asbestos removal must have an asbestos survey performed by an AHERA Building Inspector.
• Demolition with no asbestos discovered in the survey must submit a copy of the survey along with the notification. Asbestos
removal projects only may check the material presumed box if all materials are to be removed and disposed of as asbestos-
. containing materials in accordance with PSAPCA Regulation III,Article 4.
Box F. Enter the demolition project information. If the structure is to be used in a training fire, list the fire department
responsible for conducting the burn as the demolition contractor in box J. Lithe property owner has been ordered to perform a
demolition by government official,submit a copy of the order from the appropriate official.
Box G. Enter all asbestos project information requested. All multiple structure asbestos project notifications must be
submitted with a work plan including a map of the area, site address for each structure,type and amount of asbestos in each
structure,and a detailed work schedule.
Box H. Check one project category in boxes#1-8. The project fee includes the demolition fee. Asbestos removal projects
and demolition with an asbestos removal involving less than 10 linear feet or 48 square feet may be filed as project category#3.
An emergency asbestos project or demolition may be requested by checking the appropriate job size category in boxes#2-9 and
then checking the applicable emergency box in category#9. Emergency asbestos project notifications must be submitted with
a letter from the property owner explaining the necessity for the emergency. Emergency demolition notifications must be
submitted with a letter from an authorized government official or a licensed structural engineer documenting that the structure
is in imminent danger of collapse. To request an alternative means of compliance for friable or nonfriable materials,check the
appropriate job size category in addition to the applicable box in categories#10 and#11. A work plan must be submitted by an
appropriately trained individual along with the notification.
Box I. Sign the notification certifying the accuracy and completeness of the information provided on the form.
Box J. Enter demolition contractor mailing information(on back).
Mandatory amendments are required for changes that increase the project type, job size category, the types of asbestos
materials to be removed and work schedule changes. No fee is required for work schedule changes if the contractor is
participating in the Agency work schedule fax program. A$50.00 processing fee is required for all other amendments.
For technical assistance,contact Tom Hudson at(206) 689-4058,Larry Vaughn(206)689-4035 or Kwame Agyei (206)689-
4054. For inquiries concerning notification and amendment status contact Anne Morgan(206)689-4090.
PSAPCA Fotin No.r 66-160(Revisal 10/96)ACM