05-100957 , �
/
�;'Y°fFede�a'Way " Demolition Per����t #: 05 - 100957 - 00 - DE
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: WOOD
Project Address: 32864 40TH SW Parcel Number: 873204 0660
Project Description: Demolish parts of the home damaged by fire and water.
Owner Applicant Contractor
Gerald Wood &Lori Wood Lori Wood Lori Wood
32860 40TH CT SW 32860 40TH CT SW 32860 40TH CT SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
(253)838-8872
PERMIT EXPIRES March 1,2007.
Pernut issued on March 1,2005 •
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 accordanee with the laws,rules and regulations of the State of Washington and
the City of�ederal Way.
Owner or agent: � Date: �`/' � ,
�1N
p�ED
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' THIS CARD IS TO MAIN ON-SITE -
���oF ' �ommunit Develo m nt Ins r�ction Record
Y P �
Fecleral Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-100957-00-DE
Owner: GERALD WOOD
Address: 32864 40TH CT SW
FEDERAL WAY, WA 98023-2623
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 arc listed as close to sequential order as possible(rcad 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(4050)
Approved �
���
By (,� Date �
�^� ��C,:��. ....�
�'edera�way MAR p �. 2005PE R �z�� ��� � �2
M I T SF MF CO ME EL P DE EN FP
COMbfUNITY DEVELOPMENT SERVICES
33325 8TM AVEIVi7E SD[1TFI•PO BOX 9 ��',�J{'L I C A T I O N ° �
FEDERAL WAY,WA 98063-9 71 8 '�TY O F FE D / /
253-835-2607•FAX 253-835-2609 B U I L D I N ��j'� Q
www.atuoffederatwau.com �
`�
The oliom fs tred in ormaClon-an irzco iete licatlon wiit not be Pleaae t ibI in in or �
.� . � . �
SITE ADDRES8 ��O W � �� �� ( �fi• S j/�/ 8UITE/UNIT#
ASBES$OR'8 TAX/PARCEL# S � ,� Z C� �- � � � � LOT 8I2E(s� 1�D� �3DO
LFAAL DESCRIP1YOlY(e.g.Acme Fstates,Lof 1��( �K eS l V � , CQ �/��� Jr. ��
(Attach sePa�e P�.(o���ht1��de�'�P��l
'• • ' •
TYPE OF PERAd1T ❑BUII.DIN(i ❑ PLUMBIIiQr ❑ MECHANICAL
�DEMOLITIOA ❑ LLECTRICAL ❑ ENQrINEERINti ❑ FIRE PREVENTION 87CSTEffi
PR ECT DESCRIPTION(Provide deta�Ted description of work inc ded on is rmit nl
.
, � l�l ��
Ll. .
PROJECT liAME(Name of Business or Oumer Last Name)
• • • - •
PROPERTY N�E � PRIMARY PHONE
���R r� m czs�� 3s -8� Z
MAII,ING ADDRESS C1TY,STATE,ZIP
o -I-h c . a a�. �'8 o Z3-Z�z3
CONTRACTOR COMPANY NAM APPL[CANT NAME OFFICE PHONE
S� � � '
MAII.ING ADDRESS CITY,STATE,ZII' CELL PHONE
1 �
CITY OF FEDERAL WAY BU3INFS3 LICEN3E NUMBER EXP[RA110N DATE FAX NUMBER
— — _—B L � � ( ) '
CONIRACTOR5 REC3ISTRA7'lON NUMBER(copy o(prd roqai:ed with eaeL appNcatlon� EXpIRq1'ION DATE
� �
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
r' o c� (zs�) 3 8-�S 7 Z
MA[I.ING ADDRESS CI1Y,STATE,ZIP O . b Z CELL PHONE � ' I '
2 O , c�e�l (.�o� WA. (�..5`3) zz � -�
RELATIONSHIP TO PRQT CT FAX NUMHER
❑ Architect �Tenant ❑Agent o Other(DescnbeJ (Z531$3 g .g$7�
CONTACT NAME PRIMARY PHONE �MAII.ADDRESS �
� �ke onc� 00 l.co.•,
LE1�fDER �.����„��r�r�����,� xnra
��d`��t. . ����# � co�l�
MAII.ING ADDRE.4S � CITY,STATE,ZIP
� � C • • • •
�sTn�a us� �: c� w e( � PROPOSED USE Sa,�n�
ffi�BTINti AS8ESSED/APPRAI8ED VALUE $���QGIa • VALUE OF PROPOSED WORK �
SPRINKLERED BUII.DINQr? ❑ YE8 ❑ NO FIRE SUPPRESSION SYSTEM PROP08ED/REQUIRED? O YE8 ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ ffiGHI.IN� �TACOMA ❑ PRIVATE(WELL)
SEWER 8ERVICE PROVIDER VEN ❑ HIGHLINE ❑ PRNATE(8EPTIC)
�
•. ..
AREA DF�BCRIPTIOlf EIQSTIIi(� PROPOSED TOTAL
.FT. .P'T. .FT.
BASEMENT
SQ�C7 SO p S
FIRST
� � n
SECOND
5 O C�
THIRD ��
FOURTH "
l'
ADDITIONAL FIAORS(DESCRIBE)
/"
DECK(COVERED?)
GARAGE ❑ GARPORT❑ ��D
NUMBER OF FLOORS � ��� � �` �'� � � "� � ��' � �`�
""NEWHOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLIAiG PRICE $
Indicate number of each type of fixture to be insfalled or relocated as part of this project. Do not include e,�cisting furhsres to remain.
MEG'HA1VICa9L
Value of Mechanical Work ,$
AIR HANDLING UNITS EVAPORATNE�OOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS S(Commercieq WOOD3TOV ES
BOILERS FIREPLACE INSER7'S GES MISC(Describe)
COMPRESSORS FURNACES GA8 WATER HEATERS
DUCTS GAS PIPE O
PLUMBI1VoG
BATHTUBS(or7t�b/Bhavercom6o) OWERS WATER CLOSETS�Toiley MISC(DC9C17be)
DISHWASHERS SINKS DRINHING FOUNTA(NS
GAS PIPE OUTLETS SUMP3 RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS�gatt�roomsin�ce) VACUUM BREAKERS ELSCTRIC WATER HEATERS
� •
I cerNjj�under penaity ol perjury that the ir4jor�natlon jurnished by me ts tnae and corroct to the bsst oj my knowledge,and jlurther.tha!I
ane authorEsed by the owner oj the abooe premisaa!o perjornt the work for u�/Nch the perndt appHcation ia made. I Jlterther agrse to hold
har►ntess the City oj 1rls8enal Wuy as to any clatm(lnciudtng coats,e�cpensea,and attorneys'jees tncurred in ths tnvesHgatton and dejenae oJ
aueh elaimj,whieh n�qy be made by any panon,{ncZuding the underslyned,and jiled against the City of Federai Way,6ut only where sr�eh elaim
arisea out of the reitance of the eity,including its ofjteera and empWyees,upon Lhe accuracy of tlee{nformation auppHed to!he city as a part of
t/da appHcation.
r r
1�AME/TCCLE DATE �J
(signatu � (Title)
RELATIONSHIP TO PROJECT wner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
.'y3._ �k�y �
..M.+. ,�Y4
, . � . . . .. . : ,
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Bulletin#100—January 7,2005 Page 2 of 4 k�Handouts�Permit Application
� 1
� DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`�Avenue South
C17Y Of � PO Box 9718
Federal Way WA 98063-9718
Federat Way 253-835-2607;Fu�253-835-2609
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 emirontnental checklist may be required,which will extend the time period before a demolition permit can be
issued.
❑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 TOAPPLICANT: Utilities shall be disconnected and services performed,if applicable,prior to issuance of the demolirion permit All applicable
items below are to be si¢ned and dated by the respective agency representatives.
1.ASBESTOSABATEMENT 6.ELECTRICITY 3���D�Z.
(Copy of approval form and asbestos survey from puget Sound Gean Air (EI riaty to be shut off and met r 1removed)
Agency provided) �1�'. �'Z'-Y--�+�L- �O ���` �lS(OM�e�2� G�[�'" �� �1Q.
A Z S See S7`c�,'t'w, n*" � �� (PugetSoundEnergy)
Ci�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
C�'0�5 CADed a�'t' p�o�er-�-y (���, Z/zz/os under Fire Deparlment ' prior to any dismantle/excavation)
� (Pug Sound Ener ) '� �
( er I Way Fre District#39)
3.SEPTIC SYSTEM 8.WATER-Publit Source (Check applicable box)
(Tank to be removed or tank to be drained and Filed) ❑Meter to be removed and final utility bill paid
N/� �leter to remain and be protected
„� 3 �
(IGng County Environmental Services) t (Water Supplier)
:* R*****��'����`=C.�G
4.SANITARY SEWER (Check applicable box) 9.WATER-Plivate Well(Check applicable box)
❑Sewer line wpped at property line ❑Private well filled and capped
�Existing sewer line to remai and be used by proposed new structure ❑Private well to be used for ot�e.r[p1urposes
er i+ . (IGng Gou / w'ronmental Services)
�R ��
. ARB E
(All hou I�garbage disposed off and final bill paid)
_r�0
(RST Disposal/Federal Way Disposal)
❑Completed Construction Permit Application form.
❑Provide the following fees: 1.Demolition Permit Fee $61.00
2.WA State Surcharge 4.50
3.Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspection)
$565.50
Bulletin#122-September 30,2004 Page I of 1 k:�i-Iandouts�Demolition Pennit Requirements
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Received Feb-�d-ZQ06 1Y:OZpa Fra�p- Ta-P5E PaQe on1
• Med-Tox Northwest �E�„a����„
2020"A"Street Southeast E D��0�
Suite 102
Auburn, WA 98002 N O R T H W E S T
(253)351-0677
Jerry Wood Invoice number 20483
Post Office Box 24298 Date 5/31/04
Federal Way, WA 98093
Contract: L6541 Client!D: 0931
Jerry Wood
Scope of Work: L 6541 (1) PLM Sample Analysis
Contract Item 2
Lab-PLM
Activi Units Rate Amount
PLM Sample Analysis 5.00 25.00 125.00
Lab-PLM subtotal 125.00
Invoice total 125.00
Paid In Full-Thank You!
Invoice mailed 6/7/04
. ,
� � SAFE ENVIRONMENT OF AMERICA,INC.
ED -TO
N O R T H W E S T
ANALYTICAL LABORATORY REPORT
Jerry Wood Batch Received: 05/07/2004
P.O. Box 24298 Samples Analyzed: 05/12/2004
Federal Way, WA 98093 Report Date: 05/12/2004
MED-TOX Job No: L-6541(1)
Attention:
ANALYSIS: ASBESTOS IN BULK SAMPLES FIBER IDENTIFICATION KEY
NETHOD: POLARIZED LIGHT MICROSCOPY (PLM)/ ASBESTOS NON-ASBESTOS
DISPERSION STAINING
EPA 600/M4-82-020 AND EPA/600/R-93/116 ` = �-rirysoLile CE = Celluiose
LOCATION:32864 40th Ct. SW, Federal Way, WA AM - �osite W = Wollastonite
CR = Crocidolite F = Fiberglass
CLIENT PO #: �1N = Anthophyllite M = Mineral Wool
TR = Tremolite ND = None Detected
AC = Actinolite
Sample ID Asbestos
Lab No. Client No. Percent Brief Physical Description
0405024B Attic ND(1) Layer 1 - Grey fibrous mass: 98�
M.
No asbestos was detected in this
material.
0405025B 2nd Floor Wall ND(1) Layer 1 - White paint: ND,
paint/binder.
Layer 2 - Off white 'mud' : ND,
fine grains.
Layer 3 - Tan paper: 99� CE.
Layer 4 - Pink sheetrock: 3� CE,
fine grains.
No asbestos was detected in this
material.
0405026B ist Flr Ceiling ND(1) Layer 1 - Pale blue paint: ND,
paint/binder.
Layer 2 - Off white 'mud': ND,
fine grains.
Layer 3 - Tan paper: 99� CE.
Layer 4 - White sheetrock: 3� F,
fine grains.
No asbestos was detected in this
material.
2020"A"Street SE•Suite#102•Aubum,Washington 98002•qF�(�53)351-0677•FAX(253)351-0688•E-mail:medtoxnw@msn.com
Website:www.medtoxnw.com
+ - ,
' A .
' sv�Er+vaoraatr+r a u.rta+cw nc.mo
E D-TOX
N O R T H W E S T
Jerry Wood Report Date: 05/12/2004
Attention: MED-TOX Job No: L-6541(1)
Sample ID Asbestos
Lab No. Client No. Percent Brief Physical Description
0405027B Kitchen Floor ND(1) Layer 1 - Grey & purple vinyl: ND,
vinyl/binder.
Layer 2 - Grey mastic: ND,
mastic/binder.
Layer 3 - t�7hite 'rna3' : L7D, fir.e
grains.
No asbestos was detected in this
material.
0405028B Upstairs Bath 30� Layer 1 - Green vinyl: ND,
vinyl/binder.,
Layer 2 - Grey paper backing: 30�
C, fine grains.
Layer 3 - Tan mastic: ND,
mastic/binder.
Layer 4 - Off white �mud' : ND,
fine grains.
Asbestos accounts for 30� of this
material.
Labora ory Analyst(s) :
Kim Brooks
Page 2
' r
• �,. ,
NOTES:
• "ND(1)" means no asbestos detected; method limit of detection is 1%.
• The EPA considers materials that contain less than 1% asbestos not to be a hazard.
• Unless otherwise stated within the report, each sample was examined at standard temperature and
pressure in the Med-Tox Northwest laboratory for all asbestos minerals (i.e., chrysotile, amosite,
crocidolite, anthophyllite, tremolite, and actinolite). Only those asbestos minerals detected are
listed.
• Soils, vinyl floor tiles, and slurry-based materials (e.g., spray-on and troweled-on materials) can
be inhomogeneous due to the nature of their preparation. Quality control checks are performed
on 10% of the sample load to help ensure the accuracy of data.
• For samples containing >0 but < 10% asbestos, point counting by the PLM method is
recommended by the EPA (NESHAP, 40 CFR Part 61).
• The coefficient of variation for PLM asbestos samples typically ranges from 0.10 to 0.50.
Variation increases as asbestos % decreases.
• Vinyl floor tile samples may contain asbestos fibers too small to be detected by PLM. Negative
results, and results of < 1% asbestos, are not considered conclusive by the EPA. More sensitive
analytical methods, such as TEM, are recommended for such samples.
• Samples are archived for 1 year following analysis and then properly disposed of as hazardous
waste. .
• This report verifies, with respect to asbestos content, only the samples analyzed. The laboratory
is not accountable for the completeness with which a sample represents the actual material.
• This test report is not valid unless it bears the name of a NVLAP approved signatory.
• Any reproduction of this document must include the entire document in order to be valid.
• Neither the NVLAP accreditation of this laboratory nor this report can be used to claim product
endorsement by NVLAP or any agency of the U.S. Government.
• Unless otherwise specified within the report, all samples analyzed were in good condition upon
receipt by the laboratory.
• Thank you for using Med-Tox Northwest laboratory services. If you have any questions regarding
this report, please feel free to contact us.
2020 `A' St. SE, Suite 102, Auburn, WA 98002 (253)351-0677 M�����
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2020'A St.SE., Suite 102 Date: T Ic�1 Page_of Med•Tox Project No,
Auburn,Washington 98002
Telephone(253)351-0677, Fax(253)351-0688 Laboratory ID No.�`��UZHa,-C>'2�Batch No?"l3� Archive box cj�-v�.) .
Company: 1. Buik Asbestos 4. TCLP (indicate be/oiv) Organic Compound
Report to: � � a PLM Fuel 15. 8240 GCMS volatile
Street: �Z y �� � _ �� b SEM 5. TPH-HCD(WA/OR) 16. 8270 GCMS semivolatile
c TEM 6. BETX/TPH-C (WA/OR) 17. 8080 pesticide/PCB
City: . �,., State/Zip: 2. Airborne Asbestos 7. BETX(by 8020) 18. PCB oniy(by 8080) std/low
Phone: Fax: a PCM 8. TPH-G (WA/OR) 19. 8010 halogenatedNOC
E-Mail: b TEM-AHERA 9. TPH-D (WA/OR) 20. aromatic VOC
c TEM-Modified EPA 10. 8015 modified 21. 8310 HPLC PAH
Client Pro ect No.: d. TEM-NIOSH 7402 11. 418.1 (WA/OR) 22. 8040 phenol
� e. Yamate II 12. 413.2 23. 8140 OP pesticide
MTNW Project Mgr.: 3. Lead 13. AK-GRO 24. 8150 OC herbicide
Project Name:�zr��a �b+�U.S`�-� ����Ak� tia� a air 14. AK-DRO Metal
M-T will G dispose of G retum sample b W�pe 25. priority poilutant(13)
C ChIP PUT CODE NUMBER 111 AneIySIS 26. TAL(23)
Requested column sE�ow:..:
Lab ID Sample ID Analysis Lab ID Sample ID ' Analysis
Re uested Requested
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Turn-Around Time Sample Receipt Relin uishe Relin uished by: Anal zed b : �
Standard Total no.containers received Date: Date: Date: — � z
1 week COC seals present? Time Time Time:
4 work days COC seals intact? Received by• Received by: Reported by:
3 work days Received cold? Date: � Date: � Date:
2 work days Received intact? Time: 1 y c� Time:' Time:
24 hours Received via: ❑ SPECIAL INSTRUCTIONSCType of inetal analysis requested:
12 hours Antimony(Sb) G Cadmium(Cd) G Mercury(Hg) G Thallium(TI) G
8 hours ! Arsenic(As)` G Chromium(Cr) G Nickel(Ni) G Zinc(Zn) G
�---- Barium(Ba) G Copper(Cu) G Se�enium(Sej G
4 hours `�� �� Beryllium(Be) G Lead(Pb)G Silver(Ag) G
2 hours