06-105908 ' City of Federal Way •
Community Development Services Demolition Perm #. 06-105908-00-DE
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: SHRAMOVYCH
Project Address: 29919 23RD AVE SW Parcel Number: 012103 9094
Project Description: Demolishing 1 story residence
Owner Applicant Contractor
RUSLAN SHRAMOVYCH RUSLAN SHRAMOVYCH RUSLAN SHRAMOVYCH
5104 HIGHLAND DR SE 5104 HIGHLAND DR SE 5104 HIGHLAND DR SE
AUBURN WA 98092 AUBURN WA 98092 AUBURN WA 98092
Additional Permit Information
CONDITIONS:
After final inspection is complete and approved,please contact Kari Cimmer by e-mail at
Karic@cityoffederalway.com OR by fax at 253-835-2609 to receive a refund of cash bond.
PERMIT EXPIRES Friday, November 14, 2008
Permit Issued on Wednesday, November 15, 2006
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use i be in accordance with the laws, rules and regulations of the State of Washington
an he City of Federal Way.
Owner or agent: '"a ////5/�,6
Date:
4._ .1.,-1,•.-A—Q—CP
•
z y THIS CARD IS TOSMAIN ON-SITE
C, OF
TYommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 06-105908-00-DE
Owner: RUSLAN SHRAMOVYCH
Address: 29919 23RD AVE SW
FEDERAL WAY, WA 98003
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
By c�
C-'�..y Date 1--C 0
CI n of6-962-
Federal Way BEC /COMMUNITY DEVELOPMENT SERVICES 1A4LICATION
n . R M I T SF MF CO ME EL P ( EN FP
33325 8TH AVENUE SOUTH•PO BOX 9718 0 v J. 5To / /www.cituo(federujwau.rum
CITY pNG E.PT•
The ollowing is re•uired' t1rmation—an incomplete application will not be accepted. Please print legibly(in ink)or type.
■ PROPERTY INFORMATION
SITE ADDRESS OR 7/9 23rdAi
/"� I ,\ � SUITE/UNIT#
�/
ASSESSOR'S TAX/PARCEL# v/ 3 - Q LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■'PROJECT INFORMATION
TYPE OF PERMIT ❑;BUILDING 0 PLUMBING 0 MECHANICAL
-,,OLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESC�I N(Provide detaile.'_description of work included on this permit onlq)
Dern eri Fi621 o,‘" we s/or ,o�
SGS
•
PROJECT NAME(Name of Business or Owner Last Name) .�,/1 r6i1 10
al PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE OWNER p - f - cqan.fJ 4 (4373 )/%3 -39'6,
MAILN ADDRES 6102? / 6/7/ 4.51
ST E,ZIP
f4
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
()U i( ' ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
_ _ B L / / ( )
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY(NAMAPPLICANT NAME OFFICE PHONE
Ul JOU/ ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant o Agent ❑ Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( .) -
LENDER `7 f r **114A �firi NAME
� r Tm e
MAILING ADDRESS CITY,STATE,ZIP PHONE
' 1, r' ° ■ DETAILED BUILDING INFORMATION '•
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
0 0
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL o sr � • x "
NUMBER OF FLOORS a � g >4 � $ '
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
.
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS
FANS HOODS(commere.) W OODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/shower Combo) SHOWERS WATER CLOSETS(wog MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
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 defense of
such claim),which may be made by any person,including the undersigned, and filed against the City of Federal Way,but only where such claim
arises out of the reliance of th ci y, including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. y� // ` / / /
': / kt/v ////17 �"'till` DATE //////.�l//
NAME/TITLE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent ❑ Contractor 0 Architect 0 Other
MYxS* ecA f
~ ,'M, s Yn �,teyit,.lfw, Y,� 4 � �' `i.v 6' .,i:;%,"6"i";ii
Ew® Nrn �1, ;' y Nc7;
y
;
•:,.. ..:...,,-
$SP ; 144Mr ?kytuj % 1,.D ;', Al,e a ,, „,,,,,... —„,g . T,, a d d ,
A � t �-te=a -n,:a�r v a q �� �� v� p' �n A. � : '
k , 2� " !,i1kfa- ,°[ � u. � E . M � la�Y Sil3ti�� EF y ' -47,51717-141°
j �
fV _ r' 3:1' ,77::,,,,- ,', 4 ,r J" > ^ C 1°t772 � — �
•. »r a ®
r 'r , a
. et "-- � a .R (
l
idi > a ® • � � � �`fi Mu 0 ` < ., ta
. " W 7 ' ri @ 1 a as6 .
s , ' �i. voila
Rnlletin#100-January 1.2006 Pace 2 of 4 k\Handouts\Permit Application
11-13-2006 13:56 From-SKING +2534376711 1-836 P.001/001 F-669
U. L 7 4-`'..) , l+-1 v L? "I -
410
f�,� DEPARTMENT OF COMMUNITY DEVELOPMENT StaviCES
616 33325 8`h Avenue South
CITY OFen •� PO Box 9718
(...0-3 t,�(D /y� � �� Federal Way WA 98063-9718
Federal Way. ��jeco ls' ^3Q7 253-835-2607;Fax 253-835-2609
O lrwww.cityoffedcralway.com. 4 nktP
F; G� 6 DEMOLITION PERMIT
015100 REQUIREMENTS
•EPP��
P
A 't,: in it is required to remove any structure or structures on a subject property. Check with the City's Planning
Obegalein 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.
O Prior to submitting a demolition permit,the following items(as-applicable)must be signed by the respective
agency(see attached Demolition Permit Contact List). ,
•
Nott:TOAPPUc iN r. Utilities shall be disconnected and services performed,if applicable.prior to issuance of the demolition permit.All applicable
items below are to be sipnedanddated by the respective agency representatives.
1.ASBESTOS ABATEMENT 6.ELECTRICITY ove `(„
(Copy of approval form and asbestos survey from Puget Sound Clean Air city tgbe ut er moved 'Z p re t�bld%K F btu+
fro fec_icd
Agancy provided) /
�,, C.
Way 9fding fag
"crap
2.
(Puget our erg—V0).---
Ave, ceirn I
A t l 15(2o aG
2.GAS SUPPLY 7.FUEL STORAGE TANKS
(Gas to b� tpff,meter removed and final bill paid)
`Ai . (Above or bel4 g e f •I tanks,have been pumped or removed
(Puget Sound Energy) •
under Fire. pe%4 mit prior to any dismantle/excavation)
(Federal Way Fire District#39)
3.SEPTIC SYSTEM 8.WATER-Public Source (Check applicable box)
(Tank to be removed or tank to4e drained and filled) r o Meter to be removed and final utility bill paid
K.
r y J � )CMeter to remain and be protected
(King County Environmental ccs) /`� 41. . ' Wa ue ie IrT 5 e C-?
(Water Supplier) /0/l7,6ta
OR******
4.SANTTAR WER (Check applicable box) 9.WATER-Priv to Well(Check applicable box)
o Sewer!! e d i! operty rine ❑Private well filled n' .:,ped
a Existin r n /• •• air and be used by proposed new structure o Private well .. .i .[flet purposes
(Sewer Distnct) (King County Environmental Services) •
5. GARBAG
(All ho Id ag�iisposed off and Mal paid)
(RST Dlsposa!/Federal Way bill bisposai)
D Completed Construction Permit Application form
❑Provide the following fees: 1.Demolition Permit Fee $65.50
2.Automation Fcc 5.00
3. WA State Surcharge 4.50
4. Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspection)
$575.00 •
Bulletin#122—January 1,2006 Page 1 of I • k:\Handouts\Demolition-Permit Requirements
� 0• S PUGET SOUND CLEAN AII.ENCY 1 ' � ate�' i\.e� "
R 110 Union Street,Suite 500 ��
, 4ti .,' Seattle,WA 98101-2038
0 6 OCT 2 5 2006
tied0 6� np x . www.pscleanair.org
�tY`lJJ 7700 '
FEDstAN-14 Y NOTICE OF INTENT Cis=1 buUNU ULEAN
Q��v Clean Air A•enc 4Re� 1VY
gu1t.uIt1G
L.Project Type: 1. ❑ Friable Asbestos Removal 2. 4 Friable Asbestos Removal&Demolition 3. U Demolition Only
3. Property Owner: 11u5(//7 �J Arg rU 61 903 -„?79-0.,?✓[%
� Phone:
X1011 ` .,, irl
Mailing Address: l I� � City: State ea Zip: 992-
C. Asbestos PLEASE PRINT CLEARLY,THIS WILL BE YOUR RETURN MAILING LABEL.
Contractor: O /'p e r Owner/CEO:
Contractor
Mailing Address: Phone: Job No.:
City: State: Zip: Fax:
D. Site 9 (�j� G� ."
Address: 02.C J Q , t� n" City: paw/ l�`✓5y, c Zip: � C9.0 3
Site 1 '
Manager: Ra5f4gn i c/t 1" ®l�f4 Local Phone:(1-j )q95 -3 6 j
E. '= Asbestos Survey or No. of I Date of Asbestos- ri Was Friable Asbestos Identified? Yes ❑No
❑ Mat'l Presumed Structures: Survey: � ��� Was Nonfriable Asbestos Identified? ❑Yes ❑No
AHERA Building -/
Certification#:/ i7 0(0-aAt tach a copy of the survey when friable asbestos
Inspector: `1 o.vc a_ t.( T (' -‘ 6zit-,-)
/ Exp.Date: • 6 i G has not been identified.
An AHERA Survey is required before all demolition projects
F. Demolition Start A • H (0L
No. of 1 1. ❑ Training Fire(List Fire Dept.)
Information: Date: 'F Structures: 2. ❑ Ordered Demolition(attach copy of Order)
Demolition Insert tolition contractor's mailing address on back. Will nonfriable asbestos be left in place during demo? ❑ Yes No
Contractor: V W Re r If yes,list type and qty. Note disposal requirements in Step 6(on back).
G. Friable Asbestos io/ i % �Ø
�� Work Days: M T W Th F Sa Su
Project Information: Start Date: !/ Completion Date: 0 Hours:
Will all friable asbestos " Yes
Total Qty. to be Removed: Linear Ft. •Square Ft. materials be removed? ❑ No
❑ Boiler\Furnace Insulation ❑ Duct Insulation ❑Pipe Insulation r. 0 Fireproofing ❑ Paints ❑ Plaster ❑Textured Coatings
-
❑ Cement Board ❑ Cement Pipe ❑Friable Flooring ❑ Friabl R,pbt vIaterial Other: I
H. Asbestos/Demolition Project Categories: i`E CU •C__ 6 "1
Notification Period Project Demolition
1. Single-Family Residence(owner-occupied): CK. ���O .rl' ` Fee Surcharge
J_ . U
A. ❑ Asbestos Removal Project Only RCP: I`j / A. Prior Notice A. $25
B. tg Demolition Project(with or without asbestos removal project) O B. 10 Days* B. $50
*(Asbestos removal can begin u son 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 1B may be checked. If this is not an owner-occupied residence,one of the categories listed below must be used instead. A single
famil residence does not include rental property, multi family units, or any mixed-use building.
2. LI 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. ❑ > 10-259 linear feet and/or>_48- 159 square feet of asbestos Prior Notice 10 Days $100 $50
4. ❑ 260-999 linear feet and/or 160-4,999 square feet of asbestos 10 Days $200 $50
5. U >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 Residences are exempt from emergency fee;however,property owners must provide a written emergency request)
I. I certiinformation contained in this notification&supplemental data is,to the best of my knowledge,accurate&complete. Agency Use Only
i 1 .e/ntier,49
10147
Si ature Representing Date
Reviewed By
Puget Sound Clean Air Agency Form No.: 66-160(Revised 8/06)TS
411
I
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.
After receiving a complete notification with the appropriate project fee, the Agency will review the form and return a
copy to the asbestos and demolition contractor by mail. The returned copy will be your validated notification.
J. Demolition PLEASE PRINT CLEARLY. THIS WILL BE YOUR RETURN MAILING LABEL.
Contractor: Wrier Owner/CEO:
Contractor's
Mailing Address: Phone: Job#:
City: State: Zip: Fax:
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. Attach a copy of the survey to the
notification of a demolition project when only nonfriable asbestos or no asbestos is identified on the survey.
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 lA or IB 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 requests must be accompanied by a letter from the property owner demonstrating the
need to conduct the project 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 requited
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.
Puget Sound Clean Air Agency Form No.: 66-160(Revised 8/06)TS