09-105049 Demolition
• L. w City of Federal Way Permit #: 09-105049-00-DE
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: DEPT OF TRANSPORTATION-(DOT 509)
Project Address: 1808 S 356TH ST Parcel Number: 282104 9113
Project Description: ABATE AND DEMO RESIDENCE FOR DOT 509
Owner Applicant Contractor
WASHINGTON STATE DEPT OF WASHINGTON STATE DEPARTMENT OF WASHINGTON STATE DEPARTMENT OF
TRANSPORTATION TRANSPORTATION TRANSPORTATION
PO BOX 47338 PO BOX 47338 CIENVS*972CG(3/7/11)
OLYMPIA WA 98504 OLYMPIA WA 98504 PO BOX 47338
OLYMPIA WA 98504
dditional Permit Information £`
Demolition Valuation 12000
PERMIT EXPIRES Friday, December 30, 2011
Permit Issued on Wednesday, December 30, 2009
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: s�'` / .im..;,�%/..�.�� Date: /, ��
g.)
361
THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 09-105049-00-DE Address: 1808 S 356TH ST
Owner: WASHINGTON STATE DEPT OF TF FEDERAL WAY, WA 98003-8305
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 iliiilDate j )
El Rough Electrical Final Electrical ® Right of Way
Approved Approved Approved
By Date By Date By Date
q. 3-----
RECEI\ D _ / 0O' ei9
eA PERMIT SF MF CO ME EL PL D EN FP
Federal Way uEC 30 2009
COMMUNITY DEVELOPMENT SERVICES AMdICATION253-835-2607•FAX 253-835-2609 FED E'ta'�1ML.www.cihiotted,,„,,,,„„,„ L-'�J'►
R+
rr S1 0 1 1 .,- c s .
SITE ADDRESS
SUITE/UNIT# ZONING ASSESSOR'S TAR/PARCE
NAME OF PROJECT
(Tenant or Homeowner Name) 00 _
❑BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
DEMOLITION E3 ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION
PROJECT DESCRIPTION ��� - 1Le, / --e--j7
/0 - — — 47
Detailed description of work to
,5• 529 /f )
be included on this permit only c di /22CD1GJ14” �/
NAME ' PRIMARY PHONE PROPERTY OWNER / e / . 10/0- (/`TS (560),27= 23®/
G ADDRESS,CITY,STATE,ZIP E-MAIL
�K 73.3 dl ' Zed
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT ❑ PROJECT CONTACT
NAME PRIMARY PHONE
lt/11 572 e7 i1 ,7:,-/,' 1.1. (-' )7 = 9/W
7
CONTRACTOR G ADDRESS,CITY,STATE,ZIP FAX
.477//.. - i_, 9/3-?- 040 i,-,?,_xs-_ 94)-
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
6-�' "f/l/S7*9? 6 -3 / ? / /f'
NAME PRIMARY PHONE
APPLICANT 449 S r-'L (4.0)7. 57.- 9/
"ING ADDRESS,CITY,STATE,ZIP q FAX
PROJECT CONTACT NAME„ A ( � PRIMARY PHONE �/
(The individual to receive and t�i¢'A/ / `- taAl (� - 34?/(JC/l�
respond to all correspondence G ADD CITY,STATE,ZIP FAX
concerning this application) � l//� 17 �� (a�'O).2 46'
ALTERNATE CONTACT NAME: Y PHONE E-MAIL
} y `'y2,-(c (?aial ,?)c- ` '4e,
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
WW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized 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.
Ifurther 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 tom city as a part of this application.
//"
SIGNATURE: / DATE //:-.? /
PRINT NAME:_- - <' ,i�7"
Bulletin#100-4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
•Approved Transaction • Page 1 of 1
pscfeanaiir.org
Puget Sound Clean Air Agency
Notification Case #: 200902827
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 $75.00
Credit Card Transaction # VLEF4EACB9CD
Transaction Date 12/14/09
Owner's Name Wash St Dept of Transportation Phone (360) 705-7301
Project Street Address 1808 356th St
City Federal Way Zip 98003
Contact Person Gary Baldwin Phone (360) 239-1866
Mailing Address PO Box 47338
Olympia, WA 98504
This project includes a demolition.
Demolition Start Date 01/05/10 Completion Date 01/07/10
Demolition will be completed by a demolition contractor
Demo Contractor Correctional Industries Contractor Job # AW1010
Contact Steve WIlliams Phone (360) 725-91!
Mailing Address PO Box 41115
Olympia, WA 98504
(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 one Notification must be filed for each structure. The only exception is for a single-family residence that
includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If
there is no street address, I have used a building number.
(4) I understand the fees for this Notification are nonrefundable.
Create..Another Notification, View History Log__Ou.
If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058.
>,++��•���o ,,,ar,cn10nr,nrnrc,,1Act•,oc'+„c/Ar,,,-,,.,0,1 17/1d/W1A9
• • Page 1 of 2
Dept. of Labor & Industries, Division of Occupational Safety &
Health
Asbestos Project Notification Form
Form ID: 34253##1233D0C-C875940
Notice Date: 12/14/2009
Start Date: 1/4/2010
Completion Date: 1/4/2010
Status: Initial
Site Work Hours: 8:OOa- 1:30p
Site Work Days:
Monday
Contractor: D 0 C - Correctional Industries
Job Site C.A.S.: Gary Baldwin
Your e-mail address: ggbrock@docl.wa.gov
Contractor Phone Number: 360-725-9144
Property Owner
Name: Wa St Dept of Transportation
Owner's Agent: David Yoon
Company: same
Address: PO Box 47338
City: Olympia State: Wa Zip+4; 98504
Phone: 360-705-7301
Job Site
Address: 1808 356th St
Building Name: Vacant house
http://www.lni.wa.gov/safety/topics/atoz/asbestos/FormDataDisplay.asp?FormID=34253... 12/14/2009
• • Page 2 of 2
Room: garage
City: Federal Way
Zip+4: 98003
County: King
Facility
Type: Vancant SFR
Age: unk
Size: 1700
Type of activity: Demolition
Quantity of Asbestos to Be Removed Indoors
Quantity: 224 square feet
VAT
Quantity: 60 linear feet
Other:Window putty
Control Measures
Wet methods
HEPA vacuum
Manual methods
Respiratory Protection
1/2 mask APR >
Comments:
Date/Time Submitted
12/14/2009 12:37:24 PM
http://www.lni.wa.gov/safety/topics/atoz/asbestos/FormDataDisplay.asp?FormID=34253... 12/14/2009
' ORION• •
Environmental Services
An Environmental Compliance Consulting Firm
Polarized Light Microscopy Test Report
EPA Method 600/R-98/116
Client Correctional Industries Environmental Services Date December 9,2009
PO Box 41115 Page Page 1 of 3
Olympia, WA 98504-1115 Invoice 095359
Attn: Gary Brock Date Received December 9,2009
Project Number ES1141
Project Name DOT Federal Way
Client Orion Sample Asbestos Other
Number Number Stereo Scope Exam Treatment Percent Type Fibers
1808-01-OOIa 91203-102a Black Composition Roof Ash ND - Cellulose
Homogeneous Fiberglass
1808-01-001b 91203-102b Roof Felt Ash ND - Cellulose
Assoc. w/1808-01-001a
1808-02-001 91203-103 Building Paper Ash ND - Cellulose
Homogeneous
1808-03-001 91203-104 Joint Compound - ND - -
Homogeneous
1808-04-OOIa 91203-105a Texture - ND - -
Assoc.w/1808-04-001 b
1808-04-OOIb 91203-105b Wallboard - ND - Cellulose
Homogeneous
1808-04-002a 91203-106a Texture - ND .. ..
Assoc. w/1808-04-002b
1808-04-002b 91203-106b Wallboard - ND - Cellulose
Homogeneous
1808-04-003a 91203-107a Texture - ND - -
Assoc. w/1808-04-003b
1808-04-003b 91203-107b Wallboard - ND - Cellulose
Homogeneous
1808-05-001a 91203-108a Red 9x9 Vinyl Tile - ND - -
w/Black Felt
Homogeneous
1808-05-OOlb- 91203-108b Dark Mastic Chloroform ND - Cellulose
Assoc. w/1808-05-001a
34004-9th Avenue South s Suite A5 • Federal Way,Washington 98003-6740
Tacoma (253)952-6717 • Seattle(253) 874-8118 • Facsimile(253)927-4714 44 Email Info@OrionES.net
WBE W2F9219763
s a
ORIONEnvironmental Services
An Environmental Compliance Consulting Firm
■ _
Polarized Light Microscopy Test Report
EPA Method 600/R-98/116
Client Correctional Industries Environmental Services Date December 9, 2009
PO Box 41115 Page Page 2 of 3
Olympia, WA 98504-1115 Invoice 095359
Attn: Gary Brock Date Received December 9,2009
Project Number ES 1141
Project Name DOT Federal Way
Client Orion Sample Asbestos Other
Number Number Stereo Scope Exam Treatment Percent Tyne Fibers
1808-06-001 91203-109 White/Gray 12x12 Vinyl - ND - -
Tile w/Self Adhesive
Homogeneous
1808-07-001 91203-110 12x12 Vinyl Sheeting w/no - ND - -
Felt
Homogeneous
1808-08-001 91203-111 Green Marble Pattern - ND - -
12x12 Vinyl Tile
Homogeneous
1808-09-001a 91203-112a 9x9 Black Vinyl Tile Ash 4 Chrysotile Cellulose
Homogeneous
1808-09-001b 91203-112b Dark Mastic - 2 Chrysotile Cellulose
Assoc.w/1808-09-001a
1808-09-OOIc 91203-112c Leveling Compound - ND - Cellulose
Assoc.w/1808-09-00Ia
1808-10-001 91203-113 Window Putty - ND - -
Homogeneous
1808-11-001 91203-114 Window Putty - 2 Chrysotile -
Homogeneous
34004-9th Avenue South o Suite A5 • Federal Way,Washington 98003-6740
Tacoma(253)952-6717 • Seattle(253) 874-8118 • Facsimile(253)927-4714+ Email Info@OrionES.net
WBE W2F9219763
! •
ORIONEnvironmental Services
An Environmental Compliance Consulting Firm
Polarized Light Microscopy Test Report
EPA Method 600/R-98/116
Client Correctional Industries Environmental Services Date December 9, 2009
PO Box 41115 Page Page 3 of 3
Olympia, WA 98504-1115 Invoice 095359
Attn. Gary Brock Date Received December 9, 2009
Project Number ES1141
Project Name DOT Federal Way
Client Orion Sample Asbestos Other
Number Number Stereo Scope Exam Treatment Percent Tyne Fibers
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/I 16.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 IOReviewed By
Dennis Rauschenberg Donna McNeal
Laboratory Analyst Laboratory Director, CEO
Leading Environmental*Compliance Consulting Into the 2.1s"Century
34004-9th Avenue South • Suite AS • Federal Way,Washington 98003-6740
Tacoma(253) 952-6717 • Seattle(253) 874-8118 + Facsimile(253)927-4714 1 Email Info@OrionES.net
WBE W2F9219763
a,� ( + • 5 j
CORRECTIONAL. INDUSTRIES
Environmental Services / Building Assessment
SLIP
801 88th Ave.SE
Tumwater WA. 98512-1115
Phone: (360)586-0031 / Fax: (360)586-0036
Chain of Custody
TO:(Lab) f 1 v'\ \cko5
ADDRESS:
SAMPLE: TYPE NUMBER TURN AROUND TIME
❑ AIR ❑ 24 Hour
• BULK I ❑ 48 Hour j
El
SOIL >Other S T CA" 0`fC/�
❑ LEAD
NOTIFICATION OF ANALYSIS: ❑ Telephon ❑ Fax ❑ Written
ATTENTION: A( c,IC.
PROJECT NAME: bc.A uuc.,y
LOCATION: I cc.CY 5 -3 S 6
JOB NUMBER:
SAMPLE# SAMPLE DESCRIPTION SAMPLED BY CERT.7,4- •
J'cY' C(- oc ( cOF t ( y yoUy 35v� -a�
1 '() OZ-od f—c-( VD( a g-�r o 1 -25rzp
re0 k—C7'�-cxr 1 J c�1v�`�- C-c) -i 1c1 v�.�
cts"- OC - OC) —r eX�u>� �. sl - coc,
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lcrcAb--o�-OC) \ Q_ecSZ. coccir��It s� NcU
lir() 0 6 -00rod 121<Z.t
�kO 5- 001 steer U,ti.. j (Ahcke 1-241 13A411-%
Crts —00a 6-f " i1({z- 6- r4 �_
( s Q Oct-061 °O S 0 /61'1 /
()Ss' - lU-01 Ac-16-a„ Ot,, 4. ki"
RELINQUISHED BY: Correctional Industries RECEIVED BY: g_A-Ar4-0
PRINTED NAME: k C1/ r0 V\/ PRINTED NAME:
SIGNATURE: _ SIGNATURE:
.
TIME: l/,dv DATE: /z-3"O9' TIME: I Pit)(:_) DATE: la �j O
LABORATORY-PLEASE RETURN ONE COPY OF THE CHAIN OF CUSTODY WITH WRITTEN ANALYTICAL RESULTS.
NOTE:Stop testing as soon as you get 1 positive sample in any one sample catagory please.
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
• ,/"?.4 -- Yp ---'47'"---- — Sr--- /--e--eati9.(iv c3e3
33325 8th Avenue South
,� PO Box 9718
CITY OF &a ` Federal Way WA 98063-9718
Federal Way) 253-835-2607;Fax 253-835-2609
V� 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.
0 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 6.ELECTRICITY
(Copy of approval form and asbestos survey from Puget Sound Clean 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 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)
(South King Fire and Rescue)
3.SEPTIC SYSTEM tlik ATER-Public Source (Check applicable box)
(Tank to be removed or tank to be drained and filled) • Meter to be removed and final utility bill paid
Me remairyand be r tested / 047
(King County Environmental Services) (Water Supplier)
******OR******
4.SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box)
o Sewer line capped at property line o Private well filled and capped
o Existing sewer line o r ain be used by proposed new structure o Private well to be used or er p poses
( ehaven Utility District) (King Coun Environmental Services)
5.GARBAGE
(All household garbage disposed off and final bill paid)
(Waste Management/Other Company)
❑ Completed Construction Permit Application form
❑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 $4.50
4. Cash Bond Deposit 120%of calculated building permit fee
Refundable upon Completed Final Inspection
Bulletin#122-January 1,2009 Page 1 of 1 k:U-Iandouts\Demolition Permit Requirements
DEC-29-2009 10:25 Frorii:ELECTRIC RST REP 2533956806 T 3607259186 P.2/2
DEC-29-20029 09:01 From: 5339568% P.Z Z
.12.22/2009 I0;00 PAX lit0021002
�'cy& - ,A24. v 9R1C;c3
R7ii rrrOF COMMUNITY DEYEU-UrMQrrrSYRvIces
....,.._„A.
33315$w Adv nruc soul'
CITY err ,/ PO Bax 97 is
F71 Way WA DFiOb7-971E
Federal Way 281-833-260 Fan 253-83.5-21509
?+'ww.si!Lvott Sr4way..•0111
DEMOLITION PERMIT REQUIREMENTS
A demolition Permit is requited to remove any ttrnCtuTe or structures on a subject property.Check with the City's Planning
DlviNion to see if'the proposal exceeds thresholds that trigger an environntentaf review.An environmental review and
suhrnittal of an environmental checklist may be required,which will extend the time period before a demolition permit can
tie issued..
0 Prior to submitting a demva9tiaa permit,the following items(ac applicable)roast be signed by the respective
testy(see attached Demolition Permit Contact List).
ND ro APptacav- Umbria rholi Le dine nnayrd and Jcrricts perfor ntd,ifapptirable,prior co ir]koncr of Me dtmot&iun pennft AU aFPitcaMr
if("If be)uw"or w by Sued dated by the resperrmc agency rt
prricnrarn rr.
1.ASBESTOS ABATEMENT 6.—_!.
(COPY or avptvral form end Asbestos survey Flirt RS ISaaim Ai
nd dr /` _Aim
Agency prwlded> .'JA r %r`
, •
IDr
cot,of Fried Way Balding 6`fldal) 5 . QQy
'\:
2• 5 SUPPLY 7.FUEL STORAGE TANKS
Gal1s T.0 be Sita off
}.;rt, re:e:mvr40, 1 tai rcriel , �GM (Above or below graze fuel tanks,have been pumped or rernovaaz
l) �"1 ., �{ _ uncle,'Fire Department permit prior to any d smarltle/ma/3tiDn)
MA `I c •
12.�f lag t5oun,► Ree m e Raa,e]
3,SEtriTC SYSTg 'KU ■`' ‘I3 ATER_ppblteSou iie (Chace applicable box>
(Tent to be removed or tank to be drained and Ned) to be removed tad fLIA unity bill paid
etar to remain and be prate-Ad
(dna County FnYirvnmenSe h4r.e) a , .-i:, i'T.+'r
wit vas•OR•... A.
4.SANITARY SEWER (Check applicable bar) 9.WATER-Private WeN(Chick rtppticabk box)
n Sewer lite capped at vrvperty line ;2 Private,. mita MC upped
u Exiginq sewer h
be td by pmpoSei new strue2vle B Prttiee will to be - . `,....
_ _
41::1?;,,,,lRilty strict) (eery Gbit 'En raninFnt. .• res)
s.GARBAGE
(All iwusehol i garbage Disposal tiff and Vial WI paid)
Nina _ . •. . .
0 Co*npictcd Construction Permit Application form
❑Provide the following fees: 1.Demolition Permit Fee Baccd on valuation.Sac tabic ye PR 4 afthc construction permit Bail icutim_
2.Automation Fee $6.00
3.WA Stat[Surchaurge $330
- 4.Cash Bond Deposit' 120%orcalculumed Wilding permit fee
Ratiodable upon Completed Final Ini?r_etkr
tlauci in dr:2-tanwa-y 1.2109
Pale I of>
101-la> ' yr roo9tion Prnrlt R
tr,uircrracnts
P. 02
DEC-22-2009 TUE 10:45 _AN Black River EH FAX N0. 12062964919
p •
1I003/Oo3
tlarA rtTarENT ComMUNITY DE vr,LoPmLOPM ENT
SERV I CES
CITY or 'il?l 33325 8`t`Avenue South
PQ Box 9718
Federal Wa
Federal Way WA 98OF3.971q
Federal �f 253.835-7607;Fax 253-835-2609
w1 w.c' ffcr t v coo
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,
0 Prior to submitting a demolition permit,the following items(as applicable)must be signed by,the respective
agency(see attached Demolition Permit Contact List).
Norte r9ApF1.leAA%r Urilitier.cftall be disconne
barns below are to he a cted and services peoro,7ned,If applicable,prior to issuance o the den
{4z5._bp the respective agency representatives. f ialirio,!permit.All applicable
1.ASBESTOS ABATEMENT
G.
(Copy of approval form and asbestos survey From Puget Sound Clean Air ELECTRICITY
Agency provided) (Electricity to he snot off ani meter removed).
(City of Federal Way&mon,Offciap (Puget Sound Energy)
2,GAS SUPPLY
(Gas to be shut orf,meter removed and final bill paid) 7.FUEL STORAGE TANKS
(Above or below grade fuel tanks,have been pumped or removed
Puget Sound Energy) under Fire Department permit prior to any dismantle/excavation)
(south Klug rite an Res-
3• EPTIC SYSTEM 0ink to be removed or tank to be drained and tilted) ATER-Public Source (Check applicable boX)
Meter to be removed and final utility bill paid
Meter to remain and be protected
King unty Environmental ServiC (P-
(Water Supplier)
4,SANITARY SEWER
(Check applicable box) 9xi"'�**OR axs*ar
a WATER-l'd and Well(Check applicable box)
Sewer tine rapped at property line
❑Existlng sewer line ors -In .lid be used b e Private well filled and capped
sstructure q Private well to be used or°fier p poses
/ Y proposed new
(I. kehaven Utility District)
5 GARBAGE (King Coon En Ironmental Services)
(Alf household garbage disposed off and firial bill paid)
(Waste Management/Other Company)
CJ Completed Construction Permit Application form
o Provide the following tees; 1.Demolition Permit Fee Based on valuation.Sec 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 aculated building permit Ice
•
Refundable upon Completed Final Inspection
BWlerin 4122-Somata 1,2009
Page!of f
kMandoutsTemolfrinn Permit Reggimmorrt;
P.
DEC-29-2009 1 :54
•
t
DEPARTMENT OF COMMUNITY DEvELOPMENT SEKvices
33325 8`''Avcnuc South
CITY OF Lta;,;acsF"� PO Box 9718
Fe d e ra l Wa Federal 98063.9718
j[ y 253-835-26007;;Fax
253-835-2609
wwwsitvofiedcr warn
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.
0 Prior to submitting a demolition permit,the following items (as applicable)must be signed by the respective
agency (see attached Demolition Permit Contact List).
NOrrUtilities shell be disconnected and services performed, if applicable,prior to issuance of the demolition permit,All applicable
items below are 10 be.ti.eneguir.1.,
RLtic�b)'the respective agency reprecerllanve,c,
1..ASBESTOS Al3ATEMEN•f 6.ELECTRICITY
(Copy of approval form and asbestos survey from Puget Sound Clean Air (Electricity to be shut off and meter removed)
Agency provided)
(city of Federal Way Building Official) (Puget Sound Energy)
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 Seung Energy)
(South King Plre and Rescue)
3.SEPTIC SYSTEM -Public Source (Check applicable box)
(Tank to be removed or tank to be drained and filled) *ATER
er to be removed and final utilitybill
pond
op<Meter to reriiain and be protected
(King County Environmental Services) (Water Supplier)
4.SANITARY SEWER (Check applicable box) ****W• OR aA***
n Sewer line capped at property line o•WATERete well
-filledPrand Well(Check applicable box)
o ped
Exisgng sewer line o r -in4pi be used by proposed new structure 0 Private well to be u ch#o�ther
�!/ roses
(t ehaven Utility District) (King Ctount'Envlronmentat SeMees)
/".5 ARBAGE
' I household -.. •{�
' � orf and NSI, f Paid)
11111
.4
'Taste Management/Other Company)
❑ Completed Construction Permit Application form
❑Provide the following fees: 1, Demolition Permit Fee Based on valuation.See sable 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 fec
Refundable upun Completed Final Inspactien
Bulletin#122—January 1.2009
)'ape I CI I k Pia ndoutsll)emolttion Pcrmii Requirement
TOTAL P.02