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15-103905 ��.J/ Demoaijiori CityofEco .D Way Permit #: 15-103905-00-DE Com,.;un� 8 Econ.Dev.Services 33325 8th Ave S Federal Way,WA 98003 �253 Request 835-3050 Inspection Line: Ph:(253)835-2607 Fax:(253)835-2609 p Project Name: SHUDRYA PROPERTIES LLC Project Address: 33425 43RD AVE SW Parcel Number: 142103 9085 Project Description: Demolish single family residence Owner Applicant Contractor SHUDRYA PROPERTIES LLC LILIYA SHUDRYA V L CONSTRUCTION 2805 108TH AVE E SHUDRYA PROPERTIES LLC VLCON**981QR(9/22/16) EDGEWOOD WA 98372 2805 108TH AVE E 31627 44TH AVE S EDGEWOOD WA 98372 AUBURN WA 9801 Additional Permit Information Demolition Valuation 6000 PERMIT EXPIRES Friday, August 4, 2017 • Permit Issued on Wednesday, August 5, 2015 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 he City of Federal Way. Owner or agent: i!,ji / — Date: a9/5P--0)5 THIS CARD IS TO REMAIN ON-SITE Construction Inspection Record Federal Way INSPECTION REQUESTS: (253) 835-3050 . PERMIT#: 15-103905-00-DE Address: 33425 43RD AVE SW Project: SHUDRYA PROPERTIES LLC FEDERAL WAY, WA 98023-3203 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. El Final-Building(4050) - Approved By 55 Date 6(f (R- ❑ Rough Electrical Final Electrical Right of Way Approved Approved Approved By Date By Date By Date ir •RECEIV CITY OF ERMIT APLICATION . Federal Way AUG 05 2015 CITY OF FEDERAL WAY "4117 PERMIT NUMBER 5 _ 5 c ) - 1 ( 15 S D _ TARGET DATE SITE ADDRESS SUITE/UNIT# *-2 LI6�- -�, 6/0 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ TYPE OF PERMIT ❑ BUILDING D PLUMBING 0 MECHANICAL DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECTitor \ PROJECT DESCRIPTION '21'Y)r `\ N , Detailed description of work to be included on this permit only N PRIMARY PHONE PROPERTY OWNER 3i" Or (7 Fye lV �✓3'- 3- 7�0 G I�pDRES ;I�a E-MAIL c �STATE ZIP 9s3-I� `J fel au.I torn- NAME ,.,Y PHONE V L- C \' 'UG-V10,n +- s MAILING ADDRESS1/4s E-MAIL CONTRACTOR ' `"� CITY '� � ��((''���vi\I \S(T(A�TT ZII�'�,Q�j�t FAX WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# IME 1, 1)1/ LGil� PRIMAR2j2_,)' -143140 APPLICANT MAILING RRBSS I 0 K^J „hee^ �y E-MAIL CITY- e bod, J�-A Z [ Z FAX Tom'/li ci (S)utl YY 11 PRIMARY PHONE PROJECT CONTACT (The individual to receive and M)LIkG SREss,02. Aut. E-MAIL respond to all correspondence l (/1 l 7J� concerning this application) oI ' si 1.71. FAX iik CtOD al N E l 'k(� !✓' -�. ," OWNER-FINANCED PROJECT FINANCING ( I f l uci r" / ri/Licii y i ekn Required value of$5,000 or more MAI NG D E S, ITY,Ate' ATE,ZIP '' /j Z-63 PHONE (RCW 19.27.095) -77401.) 1 ' q / z • -Y1-1/6 llllll JJJ I certify under penalty of perjury that I am the property owner or au orized agent of the property owner.I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to th- city as a part of this application. � SIGNATURE: _ DATE 1 U)h PRINT N• � j T! �[ Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application • VALUE OF MECHANICAL WORK MECHANICAL PERMIT $ • Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial) BOILERS FURNACES HOT WATER TANKS(Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES VALUE OF PLUMBING WORK PLUMBING PERMIT $ Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric) HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE)In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑Yes ❑ No ❑Yes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT FIRST FLOOR(or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER(describe) EXISTING PROPOSED TOTAL Area Totals **NEW HOMES ONLY** ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL-NEW/ADDITION AREA DESCRIPTION AreaConstruction # of Occupancy Group(s) Additional Information in Square Feet Type Stories NEW BUILDING ADDITION COMMERCIAL-REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Construction #of Occupancy Group(s) Additional Information in Square Feet Type Stories TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application ! S 111111111 COMMUNITY DEVELOPMENT DEPARTMENT 33325 8th Avenue South Federal Way,WA 98003-6325 CITY OF 253-835-2607;Fax 253-835-2609 Federal \/'Jay www.cityoffederalway.com DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure on a subject property. Demolition of separate structures may require separate permits. ❑ Address of Demolition: ,'/� r ' oe A i ()ea ❑ Prior to submitting a demolition permit, the following items must be signed by the respective agency or their approvals attached. Items not applicable to your project should be marked N/A. 0 A completed Construction Permit Application form is also required. 1.ASBESTOS ABATEMENT (Provide copy of Notice of Intent from Puget Sound Clean Air Agency 5. ELECTRICITY and copy of inspection report by AHERA-certified inspector) \0/1E, (2 (City of Federal Way Building Official) 1 1 t F © Ue8% (Puget ou :j nergy) 2. FUEL STORAGE TANKS 6.GAS SUPPLY ❑ Under grade tank(s)is/are present ❑Above grade tank(s)are present ❑Tank(s)has been pumped or removed under South King Fire& (Puget Sound Energy) Rescue permit prior to any dismantling or excavation (South King Fire and Rescue) 7.WATER- Public Source 9 (Water Supplier) 3. SEPTIC SYSTEM F' D) 2cosot- g .WATER- Private Well (King County Environmental Services) ++ (King County Environmental Services) 4.SANITARY SEWER N (Lakehaven Utility District) Bulletin#I22—May 13,2015 Page 1 of 1 k:\Handouts\Demolition Permit Requirements Approved Transaction Page 1 of 1 pscleanair.org Puget Sound Clean Air Agency Single-Family Notification Case #: 201503269 This page must be printed. A printout of the notification, all amendments to the notification,and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site(Reg III,4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # AXOFD6D1BEA6 Transaction Date 08/05/15 Owner's Name Liliya Shudrya Phone (253) 227-4740 Project Street Address 33425 43rd Ave SW City Federal Way Zip 98023 Contact Person Liliya Shudrya Phone (253) 227-4740 Mailing Address 2805 108th Ave E Edgewood,WA 98372 This project includes a demolition. Demolition Start Date 08/15/15 Completion Date 08/16/15 Demolition will be completed by a demolition contractor I certify that: (1)This is a single-family residence project.The structure is used by one family who owns the property as their domicile. (2)The information I have provided is to the best of my knowledge accurate and complete. (3) I understand the fee for this Notification is nonrefundable. Create Another Notification View History Log Out If you have questions,contact us at asbestos@pscleanair.org or 206.689.4058. https://secure.pscleanair.org/Asbestos/Approved.aspx 8/5/2015 0 • { F f 1429 Ave.D.#187,Snohomish,WA 98290 425-489-4040;c 206-914-5500;f 775-665-0420 wee a:hestotesttom,ar/mnaashestote st.cum ASBESTOS SURVEY Double Wide Mobile Home (a,33425 43rd Ave. SW,Federal Way, 98023 Page 1 of 5 July 22,2015 2150725 Shudrya Properties,LLC 2805 108th Ave. E Edgewood,WA 98372 attn: Liliya Shudrya 253-224-4740; 253-227-4740 lilivashudrv(a�hotmail.com On July 14,2015,Asbesto-Test personnel conducted an 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)of the double wide manufactured home(a,33425 43'1 Ave SW., Federal Way, WA 98023. This survey purpose is to identify asbestos containing materials, prior to demolition. Note:This mobile has been vacant for a long time.The floors are rotted through in places.The structure is full of contents and garbage. There may be additional ACM inside this structure that was not discovered in this survey. If any additional suspect asbestos containing materials are located(prior to or during demolition such as but not limited to those items listed on the last page of this report),those materials are presumed asbestos containing unless tested otherwise by laboratory analyses.There should be an AHERA building inspector on site during demolition to ensure there are no additional suspect asbestos containing materials present that are not identified in this inspection. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The mobile is wood frame. The siding is wood.The roofing is composition. The composition roofing materials were sampled. INTERIOR CONSTRUCTION, FINISHES, AN FLOORINGS: The interior construction is wood and drywall.The drywall/taping materials were sampled.The vinyl flooring materials were sampled.The misc. mastic materials were sampled.The masonry tile and mortar/mastic materials were also sampled. INSULATION: The insulation was sampled. continue to page 2 Ewa - - - z ?'.; `ped • • • Page 2 of 5 July 22,2015 CB2150725 Asbesto-Test,Inc. 425-489-4040 Double Wide Mobile Home na,33425 43rd Ave. SW,Federal Way, 98023 ELECTRICAL SYSTEM: The electrical wiring insulation is not of the kind to be ACM. HEATING AND VENTILATION SYSTEM: There is an electric forced air furnace in the structure.There was no relating suspect ACM located. Note:It was not possible to dismantle the furnace d ducting to locate and/or evaluate any aitional suspect ACM may be concealeand, inside the unit, or associated in hidden areas.ddIt is our opinion anythat further handling of the furnace system should be coordinated by the project manager and/or abatement contractor. If any additional relating suspect materials are located prior to and/or during any demolition or renovation, any and all additional related suspect asbestos containing materials should be considered to be ACM(Asbestos Containing Material), unless determined to be otherwise by laboratory analysis. Any TSI that may be present inside or outside the furnace and/or ducting system including but not limited to all gaskets,joint compounds, sealants,and/or insulations,are PACM unless tested otherwise by laboratory analysis. MISC.: None. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None. #of structures included in survey:one mobile home only Requested by:Liliya Shudrya 12111, -vb YV.'rick¢r;a+.au.¢31s ...E=53.. ... Carl A.±?ykstra =as, Asbato¢ounsins Irgcecaor 011 y s ra Inspector, certified A.H.E.R.A. Accrd.#151474 Exp. May 12,2016 .=.EPA BB continue to page 3 saia 1429 Ave.D.1187,Snohomish,WA 98290 425-489-4040;c 206-914-5500;f 775-665-0420 .i v ti avhestole.rf coin;a,!vnn ashe.smlesl.com i Page 3 of 5 July 22, 2015 CB2150725Asbesto-Test,Inc. 425-489-4040 Double Wide Mobile Home (a),33425 43'd Ave.SW, Federal Way, 98023 Any and all materials identified as ACM or PACM in this report(and/or additional materials associated with the structure that may be discovered and later identified as ACM or PACM),must be professionally abated prior to demolition.ASSESSMENT AND QUANTIFICATION OF ACM FOR ABATEMENT PURPOSES AND/OR PRICING FOR REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION,AS LISTED QUANTITIES ARE NOT GUARANTEED AND ARE AN APPROXIMATION ONLY. SAMPLE#1 IS ASBESTOS CONTAINING MATERIAL ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL 1.0 SHEET VINYL FLOORING yes//chrysotile//38% non-fibrous materials, FRIABLE ACM cellulose NOTE:THE ASBESTOS IS IN THE GRAY/WHITE VINYL BACKING. THE MASTIC IS ALSO ACM AS IT CANNOT BE SEPARATED FROM THE FRIABLE VINYL BACKING MATERIAL. ORIGINAL"PLATE"VINYL THROUGHOUT-COLOR: LIGHT TAN.THIS VINYL IS THE ORIGINAL VINYL THROUGHOUT THE STRUCTURE. IT IS VISIBLE IN THE K, HALL, BATH,&CLOSETS. THIS VINYL LIKELY EXTENDS BENEATH THE WALL PLATES.—ON PARTICLE BOARD QUANTITIES OF ASBESTOS CONTAINING SHEET VINYL FLOORING MATERIAL(FOR ABATEMENT ASSESSMENT AND/OR PRICING FOR REMOVAL)SHOULD BE DETERMINED BY ON SITE EVALUATION. NOTE:ANY ADDITIONAL COLORS OR KINDS OF VINYL FLOORING AND/OR TILE WITH ANY RELATING MASTICS/BACKINGS THAT WERE NOT DISCOVERED IN THIS SURVEY AND MAY LATER BE LOCATED IN THIS STRUCTURE ARE ALSO PRESUMED TO CONTAIN ASBESTOS UNLESS TESTED OTHERWISE BY LABORATORY ANALYSIS THERE WAS NO ASBESTOS DETECTED IN ANY OF THE REMAINING SAMPLES 2.0 masonry floor tile NAD non-fibrous materials entry 3.0 mortar/mastic NAD non-fibrous materials, holding previous sample cellulose 4.0 mastic NAD adhesive,cellulose kitchen holding laminate on countertop 5.0 drywall NAD non-fibrous materials family room cellulose, fiberglass, paint,gypsum 5.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose, fiberglass continue to page 4 4,,-;:i,--EP—IATt 420 BBB N 1429 Ave.D.#187,Snohomish,WA 98290 425-489-4040;c 206-914-5500;1775-665-0420 1,11'W.ashesur f(!.s.I.C<>17?;arlynn;aashestotest_cum 410 0 Page 4 of 5 July 22,2015 CB2150725 Asbesto-Test,Inc. 425-489-4040 Double Wide Mobile Home (&,33425 43rd Ave.SW,Federal Way, 98023 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL 6.0 drywall NAD non-fibrous materials kitchen,bath,&laundry cellulose,fiberglass, paint,gypsum 6.1 drywall taping compounds NAD non-fibrous materials, sampled per ARRA guideline cellulose,fiberglass 7.0 drywall NAD non-fibrous materials dining room cellulose,fiberglass, paint,gypsum 7.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose, fiberglass 8.0 drywall NAD non-fibrous materials living room cellulose,fiberglass, paint,gypsum 8.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 9.0 drywall NAD non-fibrous materials bedrooms cellulose,fiberglass, paint,gypsum 9.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass COMMON AREAS: 10.0 insulation NAD fiberglass,cellulose color:beige 11.0 composition roofing NAD cellulose,tar, non-fibrous materials 12.0 vapor barrier NAD cellulose,tar beneath previous sample 13.0 mastic NAD cellulose,adhesive holding composition roofing continue to page 5 BBB ® C.77)r 1429 Ave.D.#187,Snohomish,WA 98290 425-489-4040,c 206-914-5500,1775-665-0420 in i4 wasbesiotestc011 arlvmt(i#,a,shestotest.com • 0 Page 5 of 5 July 22,2015 CB2150725 Asbesto-Test,Inc. 425-489-4040 Double Wide Mobile Home W,33425 43rd Ave.SW,Federal Way, 98023 Samples taken are listed with their corresponding analyses.If asbestos is detected,those samples containing asbestos are listed first and noted with the initials'ACM". Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials,as prescribed by A.H.E.R.A.guideline. If,during demolition or renovation,any additional suspect asbestos containing materials are located[may include but not limited to: sheet vinyl flooring,tile flooring,wall or ceiling texturings or paints,concrete siding or skirting,cement pipes,cement wallboard, electrical cloth,electrical wiring insulation,thermal paper,wallboard,joint compounds,vinyl wall coverings,spackling compounds,or any other suspect TSI(Thermal System Insulation)],those materials are presumed Asbestos Containing Materials unless determined to be non-asbestos by laboratory analysis. Asbesto-Test,Inc.does not guarantee approximations of quantities of ACM,which may be listed with the analyses.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 on site assessment. Any and all materials identified as ACM and/or PACM in this report must be abated prior to disturbance in renovation or demolition. PLM(polarized light microscopy)has been known to miss asbestos in small percentages of some samples,which contain asbestos, thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM(scanning electron microscope)or TEM(transmitting electron microscope),to insure analytical accuracy when asbestos is reported in small percentages Analytical test method:USEPA 600/R93/116"'(PLM);WAC 296-62-07753 App.l ""One percent is the USEPA regulatory limit for asbestos in bulk samples. xer "FRIABLE"signifies"Easily Airborne" ACM signifies Asbestos Containing Material" PACM signifies"Presumed Asbestos Containing Material" CAB signifies"Concrete Asbestos Board" < signifies"less than" TSI signifies"Thermal System Insulation" HVAC signifies"Heating Ventilating Air-Conditioning" NAD signifies"No Asbestos Detected" END OF REPORT , , , 4...... -4 �� li� . ArLynn .m' ond,Pres.,BSc. Anal 'cal 'hemist, AIHA proficient - . / Inspe . ,certified A.H.E.R.A. %,. ,. accred.#147749(Expires July 23,2015) - " 'I' ,':,EPA; BBB WO 1429 Ave.D.#187,Snohomish,WA 98290 425-489-4040,:c 206-914-5500;f 775-665-0420 1,14 aihestotesI.com;arlvnnceashesloresrcum • Public Health's Seattle & King Count EPOR I OF NN 1„S ft. )( Return completed form to Public Health-Seattle&King County,Environmental Health Division, 14350 SE Eastgate Way, Bellevue,WA,98007,Tel.1206 296-4932. Faxed co,ies will not be accepted due to data entry purposes. II c, DATE: (.1 I Z,5-- PARCEL(APN): Instructions for completing form: This form is to be completed by any persons permanently removing a septic tank, seepage pit, cesspool, or other on-site sewage system wastewater tanks from service. Complete and submit this report to the health officer within thirty (30) days of the abandonment. Authority: Chapter 13.04.054,the Code of King County Board of Health,Title 13. General Information(Please print): ; ' } Name of Owner/Occupant of Property: Address: 4 Agnilagli -c cAl.,Yek.- t k Wastewater Tank Data: Type of Sewage Tank: Septic Tank Pump Tank Holding Tank Other: Number of Compartments Pumped: ,2 Number of Gallons Pumped: Checklist Item Yes/ No Not Applicable Comments Septage removed by an approved pumper?* Tank lid removed or desuoyed? Tank void filled with compacted soil or gravel? ( )(1Le *OSS Pumper Name: 1 , p,CcW King County Certification Number: 1 Ote Reason for wastewater tank abandonment: Property being served by public sewers Property being served by replacement tank -7, Structure being demolished Comments: Report of Wastewater Tank Abandonment Revised 11/9/2012 P\3411()I