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THISPERMUTAUT ORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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PERMIT LIMM. I YEAPRE- PMRMOAVIPOPUCWATOIROKN�ISISSOTADRATYESD WITHIN ISODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
-PLIOANT. ON BEHALF 01 HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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Receipt #
EDMONDS, WASHINGTON, ITS OIFIOIAIS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCi OF THIS PERMIT SMALL NOT HE
DEEMED To MOBJFYWA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION!
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Receipt
I HEREBY ACKNOWLEDGE THAT I HAVE BUD THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN 13 CORRECr, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC.
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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ORIGINAL � FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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ASBESTOS SURVEY
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PROJECT.
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Ames Site Inspection
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647 9th Avenue North
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Edmonds, WA
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Pacific west coast Inc. G.C.
1902 Jefferson Way
Lynnwood, WA 98037
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Xps SEP.M[CES, INC-
p.0. BOX 77507 SEATTLE, WA 98177-0507
1.206.391.9957
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ARICRA CERTEMW
ASBESTOS
SURVEY I WMCnON REPORT
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April2,2002
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Mr. Steve Adler
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Pacific West Coast, Inc. G.C.
1902 Jefrerson Way
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Lynnwood, WA 99037
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Re: Site Inspection Report
647 9thAvenveNorth, EdmondsWA
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On March 22nd, 2002 KPS Services, Inc. performed and site inspection which will save as our report
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for all visible Damaged Asbestos Containing Building Materials located at 647 91h Avenuc� Edmonds,
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WA. This Site Inspection was perfimned to asceriahi the presence ofAsbestos Containing Materials and
to provide a report ofthen findings to conform to WAC 296-62-077,PSCAA Regulation 111, Section 4
and 40 CFR 763 requiremern for the identification ofAsbcaos. This report also satisfies requirements
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set by OSHAs Department oftabor and Washington State Department ofLabor and Industries for As-
bestos; Containing Material in all building prior to renavationand demolition.
Inspection Findiaw.
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A total of(i suspect asbestos containing building materials (bulk), were removed from the residence for
lab artalysis. Based on the lab analysis, 4 ofthe 6 samples came back positive for Asbestos:
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The suspect Asbestos Containing Materials sampled for analysis are as follows:
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1: 22039719trFO32702-1 Sheet Vinyl w/Backing (Kitchen)
2. 2203972OtTF032702-2 Wall Board (Living Room)
3 22039721/TF032702-3WaliB=d(liallwaY)
4:2203972VM0327024 Texture Material (Living Room)
5: 22039723tIT032702-5 Blown In Insulation (Attic)
6.22039724nT032702-2 Sheet Vinyl w/Backing (Laundry Room)
KPS Services, Inc
p. 4
Page 3
Conclusion -
Ile sample results find that the following samples contain asbestos.
1: 22039719nTO32702-1 Sheet Vinyl w/Backing (Kitchen)
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2: 22039720tTF032702.2 Wall Board (Living Room)
4: 22039722tTF032702.4 Texturs Material (Living Room)
6:22039724/rFO32702-2 Sheet Vinyl w/Backing; (Laundry Room)
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Regulation require these materials must be removed prior to any renovation or demolition to the resi-
deuce. These materials must be removed by a licensed asbestos abatement contractor.
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Although extreme thoroughness and expertise were exercised during the site inspection, existing con-
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ditions may have prevcnted the discovery ofather suspect asbestos containing material. KPS Services,
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Inc. is not responsible for materials that were out ofsight and could not be discovered with reastmable
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diligence. This survey was to determine the presence ofdamaged asbestm containing materials only.
No warranty, expressed or implied, is made,
KPS Services, Inc.
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If you have any questions please contact
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Respeaffully submitted,
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KPS Services, Inc.
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KPS Servictis, Inc
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Sr,NT BY: WL 0 SGATAC; 9004W35001 MAR�29-W
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WL LebwakKim IM M02033
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Tet 20&647.0100, � Fell:
Bulk AsbWADS FbMAn*sis
Wch 8: 22M49.00
client Project Mole
Samples Received: 6
Method: FPAf6DGR-93fII6
Pwiect Location: $47 Oth Av M EIIIIIII)MIS, WA 9M
-f�,D . �q -- CrAM S0144e M. 7024
L 4: 647 gth Av N, Edslonds, WA UM
ot 2 D,,,cd;,tlov Soft %vhite Vinyl
Nort-Fflarcitis MstefiAls: Oftr F.bMuS Mate(ML-0/0 Asbost0s TYPe- %
Fine None Ostacled ND NOFIO PRIOCtOd IV
Low 2 d2 Difteripliow Gray Wous, bacift Itith Owlesive,
Np,,44,ow Wwasw Oftw ASWIOS TYPO: %
Gk4w~Adt-'6-%,d- Woo DMOCIDO W ChicoU1636%
LAM: 2203M Cflgnt on IP a"
C,agarnamw:As a comptitya. 6=" two am 1% ampuslim
9,,, Ou"" Conpawo wo baciarod p*a on surface,
Larw 11 air 2 pacription: n,,, Ab.$Ws TYPW- %
N�Mztarww Ouw C&VsWA 2%
Cdwaaw W"~,Fi= PW-
1.,,. 2 d 2 D-gP— -I- d-ft ma-W W' ' " .
lifiededWeA AsbelabOt TYPO'- %
C40,bw 10% f4," Oslacted W
Gbee libers 2%
Lab ID. 2203WM CV,,d Sauspilis W. 11'ru"'v-
L.W I d 2 uwcft_ Mills d,,*V nWOW M bW*WM M On sullm
O*WFWILUWWt% ArbasWS'TVPG-
C.*AMIO% Men, Dhcled No
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00000oft. sidesdals.
COMMGM&Aaa point
DNOW_ **,p""d vaiM Is"Maeld
uVar I dZ MdMeol. MW Mqft��% Astmat- T"- %
NWAYMB Non, Detected to
Calcareous
,, wo bNeloted kill
Loy- 2 .6 2 beawwom VA" dIO Ottleir FbIM MdW% Aslilftlics TYW
t&=+-w=aMdKlW& Ceftbow 10% trope Detected tD
am �2%
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4= Awm Aw ta. zeem% VIA UM
Te. 2o5-%?;4lo!6,=2D&834.19M
BtAk Asbeshos Fibefs Ar@h*
By Polerized Liam Mbv-cm
Batch 0. 220464%00
C41ant Pmj&O *.r-/a
Samples Received: 6
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Method: EPAISOOR-931116
Proled LoWWn: 647 Sth AV N, Edmond$. WA 98=
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La"r I of I Deeriple, Block "brCus in3ulallon Mth Smse pleges of burned wood throughotit
mort-Fbom Materials: other Flbro%m Materials:% Asbestos Typw. %
Mass besft.W-d d�h Gla" fibers a% None Detected ND
celub" 5%
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Lxlb ID: U39—M COW SWW* It TFOW024
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Layer I of 2 Doespoon: Blackened, h0AW"raded ifirryl materiel
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wn+-ibrous Matteflatv. Other Fibrous Nhiderlals:% As bestog Type-
Fine pwfdWVDVVOkmw None Delected ND N-e Detactod ND
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Latrer 2 of 2 Dwaftlow. Gray wunr fft with adhe0e
Non-Fibroul$ MOW018: OtherFibrousMallerials:% Asbestos TYw. %
None Dateded ND
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An*nd W. COW Ev= DRAFT
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W. 11"-dwooludo"
Client: A & C Services
NVL Batch Number: 22- 05395.00
Address: P.O. Box 12668
Client Projectit: xxxx
Everett, WA 98206
Number of samples: 4
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Attn.: Mr. Tobias Arroyo
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Project: 647-9th Ave. N.
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Lab#:22045286 ClienVs #: Elect. Wire
Lab #- 22045289
ClienVs #: Windows Frames
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Sample description:
Sample description:
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LAYER 1: Black asphaltic material with paint, LAYER 2: Tan fibrous Gray brittle material
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material, LAYER 3: Black/white soft material
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ASBESTOS TYPE PERCENT
ASBESTOS TYPE PERCENT
10
LAYER 1: *None Detected NO
-None Detected
NO
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LAYER 2: *None Detected NO
LAYER 3: *Nnne Detected NO
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Lab #: 22045287 (5client's #: Kit & Bath Panel
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Sam le description.
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LAYER 1: Tan fibrous material, LAYER 2: Black b rittle material,
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LAYER 3: Tan powdery material, LAYER 4: Tan fibrous material
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ASBESTOS TYPE PERCENT
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LAYER 1: *None Detected ND
LAYER 2: *None Detected NO
LAYER 3: Chrysotile 2%
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LAYER 4: *None Detected NO
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Lab #:22045288 Client's #: Kit. Floor
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Sample description:
LAYER 1: Yellow vinyl material, LAYER 2i Black fibrous material
asphaltic material with mastic
ASBESTOS TYPE PERCENT
LAYER 1: *None Detected ND
LAYER 2: *None Detected NO
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Analyzed by: Wei Long Tai
Date: 04/12/2002
Pagel
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing......................
1E
Wall
Pier/Porch
Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final
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HEATING:
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Gas Test,...... ..............
Gas Piping .................
Equipment .................
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Commercial Final
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EXTERIOR SHEATHING
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NAILING ..........................
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'FRAMING �. ............
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FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation
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Wall Insulation
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Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
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...............
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