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15-102796Project Name: MIRROR LAKE VILLAGE Project Address: 840 SW 312TH ST Project Description: Demolish single family residence • Demolition Permit #: 15 -102796 -00 -DE Inspection Request Line: (253) 835-3050 Parcel Number: 072104 9088 Owner Annlicant City offederal way MIRROR LAKE VILLAGE LLC Community & Econ. Dev. Services 33325 8th Ave S NEW VENTURE EXCAVATING INC Federal Way, WA 98003 FILE Ph: (253) 835-2607 Fax: (253) 835-2609 BELLEVUE WA 98007 Project Name: MIRROR LAKE VILLAGE Project Address: 840 SW 312TH ST Project Description: Demolish single family residence • Demolition Permit #: 15 -102796 -00 -DE Inspection Request Line: (253) 835-3050 Parcel Number: 072104 9088 Owner Annlicant Contractor MIRROR LAKE VILLAGE LLC ZHIGUANA LI NEW VENTURE EXCAVATING INC PO BOX 6961 PO BOX 6%1 NEWVEVE920KT (6/21/16) BELLEVUE WA 98007 BELLEVUE WA 98007 PO BOX 82217 KENMORE WA 98028-0217 Additional Permit Information, Demolition Valuation.............................................7500 CONDITIONS: This parcel is located within a Wellhead Protection Area (Capture Zone 10) and must comply with FWRC Chapter 19.185 and fill out a Hazardous Materials Inventory Statement, if applicable. PERMIT EXPIRES Thursday, June 8, 2017 Permit Issued on Tuesday, June 9, 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 the City of Federal Waa�y.�1� ��� Owner or agent: Rem , 5,e U Q CWCe C1 tOnA 0d - Date: FINALED IL • City of Federal Way MIRROR LAKE VILLAGE LLC Community & Econ. Dev. Services DUMPMAN LLC 33325 8th Ave S PO BOX 6961 Federal Way, WA 88003 FIL Ph: (253) 835-2607 Fax: (253) 835-2609 PO BOX 2352 Project Name: MIRROR LAKE VILLAGE Project Address: 840 SW 312TH ST Project Description: Demolish single family residence 0 Dem6lition Permit #: 15 -102796 -00 -DE Inspection Request Line: (253) 835-3050 Parcel Number: 072104 9088 Owner Annlicant Contractor MIRROR LAKE VILLAGE LLC ZHIGUANA LI DUMPMAN LLC PO BOX 6961 PO BOX 6961 DUMPML*864KB (5/2/16) BELLEVUE WA 98007 BELLEVUE WA 98007 PO BOX 2352 GIG HARBOR WA 98335 Additional Permit Information Demolition Valuation.............................................15000 CONDITIONS: This parcel is located within a Wellhead Protection Area (Capture Zone 10) and must comply with FWRC Chapter 19.185 and fill out a Hazardous Materials Inventory Statement, if applicable. PERMIT EXss S Thursday, June 8, 2017 Permit Iss on Tuesday, June 9, 2015 I hereby certify that the above information is rrect and that the construction on the above described property and the occupancy and the pse will be in actor a ith the laws, rules and regulations of the State of Washington the Ci ral Way. Owner or agent:Date: 'CITY Federal Way PERMIT #: • THIS CARD IS TO MAIN ON-SITE Construction In ection Records : INSPECTION REQ TS: (253) 835-3050 15 -102796 -00 -DE Address: 840 SW 312TH ST Project: MIRROR LAKE VILLAGE LLC FEDERAL WAY, WA 98023-4515 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. Final - Building (4U50) Approved By Date 10 f 21 1 5— Rough Rough Electrical Approved 1:1Approved Final Electrical Right of Way Approved By Date By Date By Date t 1 GFIVM CITY Of JUN o s M PERMIT APPLICATION Federal Way CITY OF FEDERAL WAY C PERMIT NUMBER _ 1 1 _ i�2/ �_J..\ ) _U k /// �/ TARGET DATE SITE ADDRESSSUITE/UNIT .Z Wa ��o # ST, a PROJECT VALUATION $ 3�%9eILI, CO ZONING 7.Z ASSESSOR'S TAX/PAR # V TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT r ro Y La P- V I Itaelk Se ,o r 14v ,1 k 01 PROJECT DESCRIPTION Detailed description of work to be included on this permit only PROPERTY OWNER NAMEPRIMARY PHONE l k,qvy Z tt v t tqLLC z - G-186 MAILING ADDRESS E-MAIL CITY TEA I ZIP HONE NAME L LL PSA C S C� J f3 ZZ MAILINGAnD G �/ 64 i B L — - 0-� CONTRACTOR CIT 1— i STAT ZTjj n� FAX +(�rC�Ji- of ll/1/// WA STAIE CONT TOR'S IC NSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # Wfr` 4- z E -oo o-- o— -&66 \ PRIMARY PHONE p/t M44 q �,Z* - SZ MAILING ADDRESS E-MAIL ` - 1 Z APPLICANT 0 ati co, CITY LLs2. TA ZIP*�FAX D PROJECT CONTACT NAME` ,,��,/ PRIMARY PHONE! (.�[/vv� 2�' �J �2 MAILING ADDRESS J I E-MAIL - 6 % (nce O : 2 ���� ` (The individual to receive and respond to all correspondence CITY $TpT ZIP o FAx concerning this application) PROJECT FINANCING NAME OWNER -FINANCED Required value of $5,000 or more MAILING ADDR SS, CITY, STATE, ZIP PHONE (RCW 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. 1 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 the city as apart of this application. SIGNATURE: DATE ` j PRINT NAME: L V J Bulletin #100 - January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application M a 4 VALUE OF MECHANICAL WORK MECHANICAL PERMIT $ Indicate how many of each type offixture 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 comme«iap BOILERS FURNACES HOT WATER TANKS fGas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES COMMERCIAL - NEW/ADDITION AREA DESCRIPTION Area in Square Feet VALUE OF PLUMBING WORK PLUMBING PERMIT # of Stories CRITICAL AREA ON PROPERTY? WATER PURVEYOR jot SEWER PURVEYOR,, VALUE OF EXISTING IMPROVEMENTS $ EXISTING/PREVIOUS USE L i $ Indicate how many of each type offivture 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 TOTAL BUILDING DRINKING FOUNTAINS SINKS (Kacben/Utility) WATER HEATERS (E)e,trm //00 HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES COMMERCIAL - NEW/ADDITION AREA DESCRIPTION Area in Square Feet GENERAL INFORMATION Construction Type # of Stories CRITICAL AREA ON PROPERTY? WATER PURVEYOR jot SEWER PURVEYOR,, VALUE OF EXISTING IMPROVEMENTS $ EXISTING/PREVIOUS USE L i LOT SIZE (In Squwe Feet) EXISTING FIRE SPRINKLER SYSTEM? ❑ Yes No PROPOSED FIRE SUPPRESSION SYSTEM? 1-1 Yes ❑ `fvo RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL Area in Square Feet FOR OFFICE USE BASEMENT # of Stories Additional Information TOTAL BUILDING ............................................................................................................................................................ FIRST FLOOR for Mobile Home) //00 /Q ............ SECOND FLOOR PROJECT AREA, ONLY COVERED ENTRY DECK` ........... ... .... .... ................ ...... ... .... .... ......... ... .... ... ....... ... ... ... ....... .,. ......,................., GARAGE ❑ CARPORT ❑ ............................. ... ,... .... OTHER (describe) .... ............ ....... .................. ... ........ .................. ............ ................ ... _..........,. Area Totals FMSnNG 0 PROPOS® TOTAL Uaa ... ............. ..... ...... .... ... .......... ... ....... .... .......... ....................... *"NEW HOMES ONLY"' ESTIMATED SELLING PRICE $ # OF BEDROOMS COMMERCIAL - NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction Type # of Stories Additional Information NEw BUILDING ADDITION COMMERCIAL - REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information TOTAL BUILDING TENANT AREA ONLY PROJECT AREA, ONLY Bulletin #100 —January 1, 2013 Page 2 of 3 k:\Handouts\Permit Application • 44k ary of Federal Way C� COMMUNITY DEVELOPMENT DEPARTMENT 33325 8U' Avenue South Federal Way, WA 98003-6325 253-835-2607; Fax 253-835-2609 www.cityoffederalwgy.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: Q 4V S L() 014- � fel—, S4rd v ❑ 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. ❑ A completed Construction PermitAppiication form is also required. 1. ASBESTOS ABATEMENT (Provide tbpy of Notice offnte7tfrom Puget Sound Clean Air Agency & ELECTRICITY and c f inspection rt ERA -certified inspector) / I, .�- ,�,,,/ / .! Pte: D v✓iZ( i�t/G� S'G0�'�'eD � � c Y -2600 J1 " I (i of Federal Way Building Official) (Puget Sound Energy) 2. FUEL STORAGE TANKS ❑ Under grade tank(s) is/are present ❑ Above grade tank(s) are present ❑ Tank(s) has been pumped or removed under South King Fire & Rescue permit prior to any dismantling or excavation N (South King Fire and Rescue) 3. SEPTIC SYSTEM (King County Environmental Services) 4. SANITARY EWER /A (Lakehaven Utility District) 6. GAS SUPPLY See- a_. a Ce w (Puget Sound Energy) 7. WATER - Public Source (Water Supplier) S. WATER - Private Well �J / '4. (King County Environmental Services) Bulletin # 122 — May 13, 2015 Page 1 of 1 k:\Handouts\Demolition Permit Requirements Approved Transaction• is Page 1 of 1 pscIeanair,org Po,e°r'3,ni.nf4 Agency Single -Family Notification Case #: 201502129 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 # AUOFD2CO324C Transaction Date 05/28/15 Owner's Name Mirror Lake Village, LLC Phone (425) 502-1936 Project Street Address 840 SW 312 ST City Federal Way Zip 98023 Contact Person Xiaoping Zhu Phone (425) 502-1936 Mailing Address PO BOX 6961 Bellevue, WA 98008 This project includes a demolition. Demolition Start Date 06/12/15 Completion Date 07/12/15 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 If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. https:Hsecure.pscleanair.org/Asbestos/Approved.aspx 5/28/2015 Public Health a 0 • Seattle & King County Return completed form to Public Health — Seattle & King County, Environmental Health Division, 14350 SE Eastgate Way, Bellevue, WA, 98007, Tel. (206) 296-4932. Faxed copies will not be accepted due to data entry purposes. PARCEL (APN): O V © DATE: 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: 14 4 T r r~kQ 1/, Address: 4'U Su) C �- � _ , r ► l C�� —.�--� Wastewater Tank Data: Type of Sewage Tank: ,X - Septic Tank Pump Tank Holding Tank Other: Number of Compartments Pumped: Number of Gallons Pumped: gw Checklist Item__ _ Yes No Not Applicable Comments Septage removed by an approved_ pumper?* Tank lid removed or_dest_royed? Tank void :filled with compacted soil or gravel? -------------- *OSS Pumper Name: King County Certification Number: kc Reason for wastewater tank abandonment: ____ Property being served by public sewers _X_ Structure being demolished Comments: ___ Property being served by replacement tank Report of Wastewater Tank Abandonment Revised 11/13/2012 Microlab Northwest, LLC • 7609 140th PL NE. Redmond, WA 98052 Phone: 425.885.9419 Web: www.Microlabnw.com E -Mail: Heidie76@gmail.com LABORATORY REPORT Client: Betsy Zhu PO Box 6961 Bellevue, WA 98007 Phone: (425) 502-1936 Fax: Location: 840 SW 312 St Federal Way 98023 0AIHA National Accreditation # 178987 REPORT #: 202-15 DATE: May 15, 2015 E -Mail: zhu@clangston.com Name: Test Method: Polarized Light Microscopy / Dispersion Staining (PLM/ DS) EPA recommended method 40CFR Part 763, Subpart F, Appendix A Appearance: Ceramic Tile Mastic Location: Results Percentage Content / Type (%) Asbestos: Chrysotile 0 Amosite 0 Crocidolite 0 Tremolite / Actinolite 0 Anthophyllite 0 Other Fibers: Cellulose 5 Non -Fibrous: Non -Fibrous Mineral 25 Binder 70 Thank you for this opportunity to be of service. any further assistance please contact me. Signed: fLE-tdi,*-cru,tnhhr-gE{f Heidie Crutcher-Bettes, Analyst If I can provide microlab Northwest, LLC • 7609 140th PL NE. Redmond, WA 98052 4P- jF Phone: 425.885.9419 Web: www.Microlabnw.com E-Mail: Heidie76@gmail.com LABORATORY REPORT Client: Betsy Zhu PO Box 6961 Bellevue, WA 98007 '*AIHA National Accreditation # 178987 REPORT #: 202-15 DATE: May 15, 2015 Phone: (425) 502-1936 E—Mail: zhu@clangston.com Fax: Location: 840 SW 312 St Federal Way 98023 Name: Test Method: Polarized Light Microscopy / Dispersion Staining (PLM/ DS) EPA recommended method 40CFR Part 763, Subpart F, Appendix A Appearance: White Vinyl White Glue Location: Kitchen Results Percentage Content / Type (%) Asbestos: Chrysotile 0 Amosite 0 Crocidolite 0 Tremolite / Actinolite 0 Anthophyllite 0 Other Fibers: Cellulose 5 Non -Fibrous: Non -Fibrous Mineral 15 Binder 80 Thank you for this opportunity to be of service. any further assistance please contact me. Signed: H&E dt2-Graft&r-swes, Heidie Crutcher-Bettes, Analyst If I can provide Microlab Northwest, LLC 7609 140`" PL NE. Redmond, WA 98052 Phone: 425.885.9419 Web: www.Microlabnw.com E-Mail: Heidie76@gmail.com LABORATORY REPORT Client: Betsy Zhu PO Box 6961 Bellevue, WA 98007 •AIHA National Accreditation # 178987 REPORT #: 202-15 DATE: May 15, 2015 Phone: (425) 502-1936 E -Mail: zhu@clangston.com Fax: Location: 840 SW 312 St Federal Way 98023 Name: Test Method: Polarized Light Microscopy / Dispersion Staining (PLM/ DS) EPA recommended method 40CFR Part 763, Subpart F, Appendix A Appearance: White Joint Compound Location: Results Content / Type Asbestos: Chrysotile Amosite Crocidolite Tremolite / Actinolite Anthophyllite Other Fibers: Cellulose Non -Fibrous: Non -Fibrous Mineral Binder Percentage 0 0 0 0 0 A 80 15 Thank you for this opportunity to be of service. If I can provide any further assistance please contact me. Signed: fletirire- C,rrcit1w—8;&ffv-s�- Heidie Crutcher-Bettes, Analyst Microlab Northwest, LLC • 7609 140`h PL NE. Redmond, WA 98052 Phone: 425.885.9419 Web: www.Microlabnw.com E -Mail: Heidie76@gmail.com LABORATORY REPORT Client: Betsy Zhu PO Box 6961 Bellevue, WA 98007 •AIHA National Accreditation # 178987 REPORT #: 202-15 DATE: May 15, 2015 Phone: (425) 502-1936 E -Mail: zhu@clangston.com Fax: Location: 840 SW 312 St Federal Way 98023 Name: Test Method: Polarized Light Microscopy / Dispersion Staining (PLM/ DS) EPA recommended method 40CFR Part 763, Subpart F, Appendix A Appearance: Location: Results White Vinyl Kitchen Content / Type Asbestos: Chrysotile Amosite Crocidolite Tremolite / Actinolite Anthophyllite Other Fibers: Cellulose Glass fiber Percentage 0 0 0 0 0 10 15 Non -Fibrous: Non -Fibrous Mineral 30 Plastic Film 15 Binder 30 Thank you for this opportunity to be of service. any further assistance please contact me. Signed: fi&60i#- Cxwcch� -a&HV , Heidie Crutcher-Bettes, Analyst If I can provide Xiaoping Zhu From: Orr, Stephanie - InfraSource Construction <Stephanie.Orr@pse.com> Sent: Friday, May 22, 2015 7:52 AM To: David Fillmore Cc: Xiaoping Zhu Subject: RE: Mirror Lake new gas line Good Morning, Looking at the site plan, and what you proposed on the location for the future gas to go, I will cut and cap the gas at the property line. I will get this dispatched today so it should take place 10 business days from Tuesday 5/26 due to the holiday. Thanks. .?Sd & I .�.. �.. A.�... ...i t.s �„£ �.1.. .,. i c3 .d x3 la E? Y�r... . CEE,S, ...I,,.'. i . .. From: David Fillmore [mailto:DavidFillmore@sifts-hill-engineers.com] Sent: Thursday, May 21, 2015 5:08 PM To: Orr, Stephanie - InfraSource Construction Cc: Xiaoping Zhu Subject: RE: Mirror Lake new gas line Stephanie, I just left you a voice mail regarding the Mirror Lake Village project. I've attached a copy of our Site Survey as well as our proposed site plan, showing the various proposed utility main connections. We are flexible on the location of the future gas service, please feel free to provide input as deemed necessary. Please give me a call with any questions or concerns. Thank you, David Fillmore, P.E. ■ SITTS & HILL ENGINEERS, INC. CIVIL ■ STRUCTURAL ■ SURVEYING htto: // www.sitts-hill-engineers,com/ From: Xiaoping Zhu [mailto:Zhu@clangston.com] Sent: Thursday, May 21, 2015 4:09 PM To: David Fillmore; stephanie.orr@pse.com Subject: Mirror Lake new gas line • K David, Stephanie's company is the gas supplier through Puget Sound Energy. The house at 840 SW 312, FW has gas line. We need to remove that gas line. But Stephanie wants to find out where is our new project gas line. Then she can decide they need to remove the old gas line from where. Can you email her our gas line chart? Thanks Betsy Zhu President Washington Clangston Investment Group Tel: ( 425 ) 502-1936 Email: Zhi u@Clangston.corn PO BOX 6961 Bellevue, WA 98008 U. S. A. z Xiaoping Zhu From: Kathy Brown <KBrown@lakehaven.org> Sent: Thursday, May 21, 2015 11:15 AM To: Xiaoping Zhu Subject: RE: 836 & 840 SW 312th St - Meter Removals See responses below. Kathy From: Xiaoping Zhu [mailto:Zhu@clangston.com] Sent: Thursday, May 21, 2015 10:29 AM To: Kathy Brown Subject: RE: 836 & 840 SW 312th St - Meter Removals Thanks for your form. I do have some question. 1) 1 do need to keep 836 water meter for water need during construction. But I still need to stop water running during demolition. in this situation, does your company still need to send a person to stop the water or we just stop it at the meter by ourselves? You can turn the meter on/off, 2) If we keep one meter, how much for monthly basic fee? The base charge is $12.35/month + consumption 3) If I want to keep meter for 836, 1 do not need to submit the form for 836, right? Correct 4) Can I pay you through phone from credit card for 840? Unfortunately we are not set up for that for these types of charges. Payment needs to be check (preferred) or cash. Thanks —xi1, Betsy Zhu President Washington Clangston Investment Group Tel: ( 425 ) 502-1936 Email: ZhuC@Clangston.com PO BOX 6961 Bellevue, WA 98008 U. S. A. From: Kathy Brown [mailto:KBrown@lakehaven.org] Sent: Thursday, May 21, 2015 8:56 AM 1 . - 0 �► To: Xiaoping Zhu Subject: 836 & 840 SW 312th St - Meter Removals Meter removal forms attached for the subject properties. The charge is $100 per meter. You may want to consider retaining one, or both, to have water available to control dust during the demolition process. You may also wish to utilize during the future site development/new construction. Please let me know if you have any questions. Kithy Br own L<,Kch,,�ver; Udity PiSti,iCt �X: tij---'-9 � kbr-o�,vi)0la ehaven.org NOTE: Lakehaven Utility District neither warrants nor guarantees the accuracy of any facility information provided. Facility locations and conditions are subject to field verification. All fees and charges subject to change without notice.