20030657.pdfI
MAILING ADDRE!
CITY
ADDRESS
CITY
NAME.
DATE
CITY OF EDMONDS
'RUCTION PERMIT APPLICATION
AE QF-BUSINE TS-N _N
ZIP TELEPHONE
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ZIP I TELEPHONE
CBL #
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PERMIT EXPIRES - zjag�
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6SE PERMIT
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NUMBER
JOB S
I C SU #
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ADDRESS
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PLAT NAME/SUBDIVISION NO.
LOT NO.
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LID NO.
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LID FEE $
I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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TF5UP APPFM
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RW Permit ReqVirsd
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I EXISTING PROPOSED
Inepww" RequLfed
Sidewsk Required
REQUIRED DEDICATION— FT
Underwound
Wiring required 13
METER SIZE
LINE SIZE
0. OF FIXTU RES
PRV REQUIRED
T
i YES13 NO 13 11
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
d
DATE
FIRE REVIEWED BY DATE
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ZIP TELEPHONE
PR&INSPECTION REQUIRED
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COMMERCIAL
COMPLIANCE OR
13 CHANGE OF USE
Dump AT APPROV13D DU4P SITE ONLY
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REM ODEL
MULTIFAMILY
SIGN
PARKING DATE
PRO ffffN
REOD ' �H
C T N BACK OF JOB CARD
I CPAI S
REPAIR
GRADING
CYDS
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REMARKS klUK INSPLA;'l U14 KrAjUlKWENTS
DEMOLISH
1:3 TANK
OTHER
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FIRE ALARM
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NUMBER OF
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SPECIAL INSPECTION AREA OCCUPANT
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REQUIRED[] YES
EN6UMBER
DESCRI183E WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTIONREG'D
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$
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SO
�RCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CH I
KN �;/ VESTED DATE
Plumbing
bO '/
Mechanical
THIS PERMIT
UJTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DOME
ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
a DOMAIN
-S. ETC.) WILL REQUIRE
CURBS, SIDEWALKS, DRIVEWAYS, MARQUEE
:3
t:
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 180DAYS
CL PERMIT
LIMIT: I YEAR - PROVIDED WORK 15 STARTED WITHIN Igo DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT,
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTERE
AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS,
SHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS I
OR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE I
ISUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
DEEMED TO
NOR LIMIT It
JOOIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ANY WAY THE CnY8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
I HEREBY ACKN)WLEDGE
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORf
THE OWNER. I
ECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
kGREE TO COMPLY WrTH CRY AND STATE LAWS REGULATING CONSTRUC-
CALL
as 1 icallon Is not a permit until signed by the
TION; AND IN D)ING
IN VICLATIC, 4
THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
B ildin
FOR INSPECTION Mc
.1 ' his/her Deputy: and Fees are paid, and
ptisacknowladge In space polded.
C
WORKMEN'S C
MPENSATION INSURANCE AND RCW 18.27.
sl URE DATE
SIGNITURE (OWNER
OR AGENT) , DATE SYNED
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kunk_L&
'K 1101
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771-0220 E
BY DATt
ATTENTION
EXT 1333
IT IS UNLAWFUL
TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INS�ECTION
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OC
UPAN Y HAS BEEN GRANTED. UBC SECTION 109
C�
PINK -OWNER GOLD -ASSESSOR
04/02
PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
: A-T
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ASBESTO-TEST, INC.
ASBESTOS SURVEY
8526 Main St., Edmonds, WA 98020
Page I of 5
VV#231008
October 10, 2003
Sandquist Homes
P.O. BOX 958
Lynnwood, WA 98036
Attn: ?&nson Kerner
Ph: 425-775-8663 xI IS Fax: 425-778-0822
INTRODUC77ON
On October 6, 2003, Asbesto-Test personnel conducted an Asbestos survey (per
U.&E.P.AJAM.E.R.A. guidelines as designated and specified by Puget Sound aean Air
Agency and Washington State) of the house & gqLage 0, 8526 _Mgk St. Ndnionds. Sn--ojo_m1sh
Cann& W
gthiftion 98020. This survey purpose is to identify any Asbestos Containing
Materials that may be present and will require professional removalprior to denwIldon.
NA—RRATIMOFFBVDINGS
BASIC CONSTRUCTION: The house is one story wood ftam& The exterior siding is wood.
The roofing is composition. The wood siding vapor barrier and composition roofing materials
were sampled.
INTERIOR CONSTRUCTION., FINISHES., ANDnoORINGS: The interior is drywall
and wood. The drywallhaping materials were sampled. Vinyl and tile flooring materials with
relating backings and mastics were sampled per each located homogenous area. The "POPcorn"
ceiling was representatively sampled.
ELECTRICAL SYSTEM: The electrical wiring insulation is not of the kind to be ACM and
was not sampled. Any additional suspect electrical wiring insulation or any suspect ZSI
(Thermal System Insulation) found in, around, or behind any locatedJuse or breaker boxes
should be considered to be A CM (Asbestos Containing Materiap, unless determined otherwise
by laboratory analysis.
CONTINUE TO PAGE 2
1429 Ave. D. PMB #187, Snobomisb, WA 98290 pb: 206-914-5%0 tax: 360-50-2469 page: 206-540-2401
L '01
dt,t,:TD ED 11 -40D
f
Odober 10, 2003
Asbesto-Test, Inc. (206) 914-SSOO
8526 Af s. Snohomish Couft Washington 98020
-pin St., Edmond
ATTIC/WALL INSULATION: There was no visible suspect ACM located.
HEATING AND VENTMATION SYSTEM: There baseboard/wall electric heat in the -
a It
house. There was no visible suspect ACM located associated with the he ting units. Note. was
n ot possible to dismantle the heating units to locate andlor evaluate any additional
suspect A CM which may be concealed, inside the units, or associated In hidden areas. It
V
is our opinion anyfurther handling of the heating units should be coordinated by the
project manager andlor abatement contractor. If any additional relating suspect
materials are locatedprior to andlor during any demolition or renovallon, any and all
additional related suspect materials should be considered to be ACM (Asbestos.
Containing Material), unless determined to be otherwise by laboratory analysis.
Misc.: The window glazing was sampled.
..... . ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: The garap is
adjacent to the house. The roofing and siding is homogenous with the house. There was no
additional relating suspect ACM located. The structure is all wood on concrete.
one house& one garage
#q in survey.
f structures included
-M
Requested by. anson Kerner
"s'
&Lym Hmmond, B.Sc.
Inspector, certified A.H.E.RA.
J.
accriedICLAY 5327 lExpires S/ 12/04)
A-T
continue to page 3
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Page 3 of 5 October 10, 2003
IN#231008 Asbesto-Test, Ina (206) 914-SSOO
8526 Main St., Edmonds, Shohomkis countp Washington 98020
Any and all materials identified as ACM or PACM in this report (and/or additional materials
associated with the structure that may be discovered and later identified as ACM or PACM), must
be professionally abated prior to demolition. ASSESSMENT AND QUANTIFICATION OF ACM
FOR ABATEMENT PURPOSES AND/OR PRICING FOR REMOVAL SHOULD BE
DETERMINED By ON SffE EVALUATION, As LISTED QUANnMS ARE NOT
GUARANTEED AND ARE AN APPROXMIATION ONLY.
%S"PLE#1 IS ASHES= CONTAINING MATERML
ANALYSIS YD ASHESTO����� OTHER MATERIAL
1.0) "POPCORN" CEH.JNG yes # chrysotile H 2-5% non -fibrous materials,
FRL4BLE ACM cellulose, foam
ALL OF TEZ "POPCORN" CEILING MATERIAL INSIDE THE STRUCTM IS
PRESUMED TO CONTAIN ASBESTOS. SAWLED PER AHERA PROTOCOL-
APPROX 400 TOTAL SQ. Fr -
NOTE: Any additional colors or Iduds of floor tile and/or mastics bacMags that were not
discovered in this survey and may later be located in this structure are also Presumed to
contain asbestos unless tested otherwise by laboratory analysis
THERE 'W—AS NO ASBESTOS DETECTED IN ANY OF THE SAWLES
2.0) drywall
WAD
non -fibrous materials
cellulose, fiberglass,
paint, (gypsum)
2.1) drywall, taping compounds
WAD
non -fibrous materials,
SAMPLED PER AHERA PROTOCOL
cellulose, fiberglass
2.2) surface paint (homogenous throughout)
WAD
paint cellulose
3.0) die flooring
WAD
non -fibrous materials
Idtcben & bath surbee-color. brown wood pattern
3.1) mastic
WAD
adhesive, cellulose
4.0) tile flooring WAD
non -fibrous materials
middle hall -color: off white & brown design
4.1) mastic NAD
adhesive, cellulose
5.0) tile flooring WAD
non -fibrous materials
back bedroom -color: brown & tan
5.1) mastic NAD
adhesive, cellulose
A-r
continue to page 4
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Page 4 of S
'October 10, 2003
VV#231008
Asbesto-Yest, Inc. (206) 914-5500
SS 2 6 Main Sit Edmonds Shokondsh Countp WashkEton 98
ANALYSIS ED ASBESTOSYMEHOUANTITY
OTHERMATERIAL
6.0) sheet vinyl flooring
NAD
non -fibrous materials
laundry --color-. tan diamond pattern
cellulose, fiberglass
6.1) mastic
NAD
adhesive
7.0) sheet vinyl flooring
NAD
I non-fibroim materials
bathroom 2 d layer -color: cream
cellulose, fiberglass
7.1) mastic
NAD
adhesive
8.0) tile flooring
NAD
non -fibrous materials
ldtchen surface -color. honey brown
8.1) mastic
NAD
adhesive, imllulose
9.2) sheet vinyl flooring
NAD
non -fibrous materials
Idtchen 2R' layer -color: tan design
cellulose, fiberglass
8.3j mastic
NAD
adhesive
8.4)'tile flooring
NAD
non -fibrous materials
Mtchen bottom layer -color. white
8.5) mastic
NAD
adhesive, cellulose
9.0) window ghtdng
NAD.
nori-fibrous materials,
house
cellulose
9.1) window ghudug
NAD
non -fibrous materials,
garage
cellulose
10.0) composition roofing
NAD
cellulose, tar, fiberglass,
& underlying materials -house
non -fibrous materials
10.1) composition roofing
NAD
cellulose, tar, fiberglass,
& underlying materials -garage
non -fibrous materials
11.0) wood siding vapor barrier
NAD
cellulose, tar
material beneath wood siding exterior -house
A-T
continue to page 5
Do Dbl_ sat, - 52t, dgt,:ID 60 11 400
Page 5 of 5 October 10, 2003
RV#231008 Asbesto-Test, Ina (206) 914-5500
8526 Main St., Edinonds, Shohondsh Coun& Washington 98020
NOT TO SCALE
MAIN ST.
WHOUSK G=GARAGE
some sample analyses listed may be a representative analysis of individual and separalesamplings and analysis of
homogenous materials, aspreicribed byARE&A protocol.
Samples taken are listed with their corrwpanding analyses. Ifasbestor Is defected, those samples containing asbestos
are lisledfirst and noted with the Initials "ACW
If, during demolition or renovation, any additional hidden or covered suspect materials similar to those identyled In
the survey are located tmay Include iut not limited to: sheet viny1flouring, tileflooring, wall or ceiling texturings or
points, concrete siding or skirfing, cement p4m, cement wallboard, electrical cloth, electrical ;v . Iring insularloit
thermalpaper. wallboard, Joint compounds, vinyl wall coveringS, spackling compounds, or any other suspect T31
(Thermal System Insulation)]. they should be treated as Asbestos Containing Materials unjejs determined to be non -
asbestos by laboratory analysis.
Note: Asbesto-Test, Inc. does not guarantee approximations orquantities of ACM, which may be listed with
the analyseL It Is therefore recommended proresslonal abatement price and/or disposal quotes be obtained by
Inquiring as to fees per area of specific ACM material (i.e. square or linear font, etc.). or by on site assessment.
ny mid all maWiak ideidyled as ACMin this report must be abatedpriar to ACM difturhancA renovation, or
demoffilom AM matMals ld=411ed as ACK must bepwfasionally abated by a licensed asbewas abotemew
caaftefor prior to any a7murbanct.
analytical ted moth*& USEPA 600/R93/1164, (PLM); WAC 296-62-07753 App. J
LejL ACM siolltes"Asbestas Containing Material"
PACM sigmitics"PnnumctlAsbmoscwuwnsmazdar
CAR sipffics"Concrett Asbestos Board*
-C sipffics"Icss than"
TSI signifin "Thermal System Iasulst;W
HVAC sipifles"HcadngVent&14Aii%.Conditioning"
NAD signifies'No Asbestos Detected"
"Ona-Ve row, Isthe USEPA replatory limit tbrasbestos in bulk samples.
PLM hu been known to miss asbestos in small percentaces Of SOOIC WOM WhiCh contain asbertas, thus neptive, PLM results cannot be
Suarantoed. Floor dies and wipes should be tested with SEM at TEM, to inSuTO analytical Accurney when rqorted in small percen"es.
Asbesto-Test, Inc. claims responsibility for sample content only.
FNP OFREPORT
ArLynn Hmmond
Analytical Chemist, B.Sa
AlHA proficient
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L GARAGE: 480 SF
FOLLOW PRE —DEMOLITION PROCEDURES PER CITY OF
EDMONDS HANDOUT
8526 MAIN STREET
Lovell—Sauerland & Associates, Inc. DEMOLITION PERMIT PLOT PLAN
"moltm'd MADRONA COVE PRD 02-171
LMR
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MENAND Fh \Proj*cts\01-8043\dwg\Design\htplem dwg
UPDATED AUG 28 ZW2 13,281 11 (lot 2D Mikeh
LSA JOB NO. 4486
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RE -INSPECTED OUTSTANDING ISSUES GRANT ]FINAL PROJECT APPROVAL
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Date -------
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