20040850.pdf- FDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
q N S-5 c, 0 0 1AA)
MAILING ADDRESS
,,+ L� 10 1 s r C
CIT�', ZIP TELEPHONE
2- 7 75661
NAME
7V
t ADDRESS
CITY ZIP TELEPHONE
j PERMIT EXPIRES -
USE PERMIT
ZONE K5 oe::7" N U M B E
JOB
ADDRESS
PLAT NAME/SUBD
NO. I LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- Fr
METER SIZE LINE SIZE NO. OF FIXTURES
SUITEIAPT#
. C-- - le, 2
LID NO.
LID FEE $
TESCP Approve()
RW Permit Required
Street Use permit Roq'd
Inspection Required
SidoWalk Required
Underground
WinnU required
PRV REQUIRED
YES M NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NAME As. H Co14 cc-) Ns�wwc,-R o�, J
CBL #
ENGINEERING REVIEWED
ADDRESS
4 S -i�& ec,
FIRE REVIEWED BY
CITY 0 1
L A CA
ELEPHONE
e
ir ;f 2-S
VARIANCE OR CU
STATE LICENSE NUMBER EXPIRATIONPATE
A,S ei co tic i el 6 q /.a Ytg)b
CHECKED BY
6
SEPA REVIEW
COMPLETE , EXEMPT
EXP
PROPERTY TAX ACCOUNT PARCE 0. 1
e 0 J 7 rcyD 7 0 43 (0 2-
NEW KRESIDENTIAL PLUMBING/ MECH
LOT COVERAGE
ALLOWED PROPOSED
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
PARKING
REO'D PROVIDED
I
I
1:1 REMODEL E] MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS E] I X FT)
REMARKS
�/DEMOLISH TANK OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
I CARPORT ROCKERY FIRE ALARM
(rYPE OF USE, BUSINE. OR ACTIVITY) EXPLAIN:
df_!� ., 'r, �'. ) I I
CHECKED BY
I 7PE OF
M NUMBER NUMBER OF
0 OF DWELLING
M
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
FW 0 k." k— li k( if
HEAT SOURCE I GLAZING %
PLAN CHECK
M
SHORELINE OR ADB#
DATE
DATE
INSPECTION
REG
E]YES $
1 1-
ALLOWED . PROPOSED ALLOWED
BOND
POSTED
[IT
PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR I FRONT LJR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
CRITI C A�L
AREA 7.y SPECIAL INSPECTION AREA
NUMBE 4 � REQUIRED [] YES I
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIr 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE qSRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE WNER. AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TIO , AND IN ING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
iii
WORKMEN'S C MPENSATION 4N SU RANCE AND RCW 18.27.
DATE
GROUP
OCCUPANT
LOAD
0
Z
cc
ut
ul
z
z
REMARKS ja�
PROGRESS INSPECTIONS PER UBC 108 / IBC11 09 / IRCII 09 FINAL INSPECTION REQ'D 9
SIGN R GENT) _\ DATE SIGNED
1 77) 1 Otf I --I A I
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
122 i�
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp-
Total Amt. Due
Recording Fee
Receipt N
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Otficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
_�,f S SIGI�AT RE DATE
OIF/F
RIYLEAS9b BY' DAT7'
ATTENTION f E)ff 1333
I, r is UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTI LA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
M
10
z
0
1
0
M
:1 =n-
M
M
0
—40
0 C
M
M Z
o -n
n
M M
0
0
0 M
C cl)
9 1:1)
M C)
Z
z
__q
M
W
z
0
i
0
M
Asbestos Survey
Pool & Pump House
9307 22 Oth St SW
Edmonds WA 98020
z
0
M
M
C
M
0
0
0 C
M
to locate and identify
M z
--i
suspected asbestos containing building materials
z
3:
3:
M M
V5
0
Inspected on October 21, 2004 for
0 M
C CD
M
M 0
z
Ashcon Construction, Inc.
M,
nd St
1312 2
3:
Kirkland WA 98033
>
z
k"
(425) 822-3009, fax: 822-2679
RECEIVED
z
0
NOV 0 4 20011
M
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
Affordable Abatement, Inc.
3732 Smith Ave #B
Everett WA 98201
Survey
to locate and identify
Asbestos Containing Building Materials (ACBM's)
Subject property : Demo pool & pump house Submitted to : Ashcon Construction, Inc.
9307 220th St SW 1312 2nd St
Edmonds WA 98020 Kirkland WA 98033
(425) 822-3009, fax: 822-2679
Lab analysis by: NVL Laboratories, Inc.
22000 64th St W #2-E Property Owner: Unknown
Mountlake Terrace WA 98043
(425) 712-5227 Date of Inspection : October 21, 2004
En)W B*W DOW BOW Bz)03 LOW Bz)cZ Bz)cz Bz)CZ Bz)CZ Zz)CZ L�Q)W L003 DOCZ BOCZ EOC6 WW Dz)(Z WCZ
Puroose
The above address was inspected to locate asbestos in accordance with federal and state laws. The
sampling methods specified in 40 CFR 763.86, a sub -section of the Asbestos Hazards Emergency
Response Act (AHERA), were employed with the following specific purpose in mind
Safety - Intended operations present the potential for disturbance of an ACBM. This
report was prepared to facilitate employees safe performance of normal activities.
Removal. Specifically this survey anticipates:
F-1 Renovation. This may not include use of destructive search methods (i.e., -
breaking into walls, etc.) unless expressly directed by client in writing.
Z Demolition. Destructive search techniques are highly recommended and may be
implied by statutes which require identification of all suspected ACBM's prior to
demolition. [as in 40 CFR 763.85 (a)(4)(i)]
F-1 Management. Information herein will be used by the property owner to develop an
appropriate Operations & Management (O&M) policy to reduce the likelihood of
exposure to building occupants for ACBM's which will be left in place.
El Property Sale - Public buildings, including commercial and industrial facilities are
required to use an accredited inspector [see the Asbestos School Hazard Abatement
Reauthorization Act (ASHARA)]. Private buildings may be inspected to compliment an
appraisal.
Methods
Currently only persons having the AHERA Building Inspector training are considered acceptably
accredited by all governmental agencies.
Mandated AHERA procedures are:
e training (for the inspector)
* examining (materials which the inspector suspects)
9 identify (by sampling or by assuming material isan ACBM)
* assessing (friability, condition and potential for damage)
2
Z
0
1
0
M
orn
C
MO
0
__10
0 C
--i ?.
= M
M Z
1c)
C
E:
C0
0 -n
n
M rn
0
0
0 M
C C/)
9 W
Q 0
Z
Z
Z
0
1
0
rn
* documenting (the above with locations)
Procedures for sample collection often seem complicated to the layperson. What appears to be the
same material located in different areas, may, or may not, require additional samples, depending on
the usage of each area. Sprayed and troweled on materials require at least three tests to confirm they
are not ACBM. Differing quantities of suspect homogeneous materials also affect the number of
samples needed.
Analysis of samples must be done by an accredited laboratory.
Assessing friability is done per the EPA definition that the material can be crumbled to a powder using
hand pressure. The forces expected to act on any material cannot be anticipated by this inspector.
An accredited Asbestos Management Planner should be consulted for assessments of condition or
potential for disturbance.
Estimated quantities are given as a courtesy and should not be relied on for bid purposes. An
accredited Asbestos Pro*ect Designer is required for quantifyin ACBM's.
The inspector who prepared this report hereby certifies by signature below, that:
• has received training pursuant to 40 CFR Part 763, Sub -part E, Appendix C
• has had at least ten (10) years professional experience in the asbestos abatement field
• used his/her best efforts in locating suspect ACBM's
1010244 June 30, 2005
Bill Schroeder Certification # Expiration Date
Certif irate of Comptetion
lgbk; i-4 to certtfp Mat
Bill Schroeder
fjw� ssatk1actortIp conipleteb
4 bour-4 of refre0jer traiiiiiiIj a!5 att
Asbestos Building Inspector
to Eontply tuitli t1je training rewtirentent!5 of
T,_—'5CZ( Title 3J3J / 40 Tff3A 763 (A32)OR21)
Certificate Number 1010244
r)
Instructor Date(s) . ofTraining
SAFM - TPLAININGINFUSTNAL HYCIENE
Provider Cert. Number: N109907012
Exam %)rc:
Expiration Date: Jun 30, 2005
Argus VacifiC. Inc. - I�W W. Nickemnn, Suile 315 - Seattle, Washington - (14119 (206) 2853171 (206) 285.3927 i
3
z
0
1
0
M
--i -n
3:
C M
M 0
0
0 C:
M
M Z
jo
C
3:
0 -n
n
M M
C)
0
0 M
C C/)
Q 0
Z
3:
z
z
0
q
0
M
Limitations
Sampling location drawings are not to scale.
Samples are believed to be representative of similar materials found throughout the areas inspected.
Items not attached to structures are not normally addressed by this type of report.
Reasonable discovery efforts were used in preparing this report. Standard industry practices
recognize that every square inch of a building cannot reasonably be exposed during the survey
process, especially in occupied structures. Wall interiors, underground pipes, septic tank liners, every
area under carpets or burn debri, are all examples of this. Consequently, some materials may remain
concealed which are not identified in this report. Materials not addressed in this report should
be assumed to contain asbestos until determined otherwise by an accredited professional. The
results of such analysis must be incorporated by addenda into this report prior to disturbance of these
materials. A copy of this report must remain onsite during such activities.
This inspection was prepared in a manner intended to comply with statutes governing the specific
purpose stated herein and can be expected to become outdated as regulations, site conditions or
usage of this information change over time.
Most demolition projects must submit this report with their "Notice of Intent to Remove or Encapsulate
Asbestos" form required by local air pollution agencies. Typically these are filed by the abatement or
demolition contractor. Permit filings are not included with preparation of this report., however, the
permit forms may be attached herein.
Site specific:
Occupied El Yes No
Unlimited access 0 Yes/ M No
Limited scope El Yes/ 0 No
Destructive sampling 0 Yes / El No Discreet
Structures
A survey of 2 structure(s) occurred on the date listed in the head of this report. This is a swimming
pool and adjacent pump house.
Historical
Historical records F] were were not (check one) examined for use in this survey. These
structures are believed to have been built in the 1970's.
General Notes
Following is a description of the construction systems noted at the site.
Pump House
Roofing - This is a nearly flat roof which consists of roof tar applied directly
to a plywood substrate.
Walls (interior) & ceilings Interiors are unfinished.
Wall surfaces, exterior - The exterior is CMU block only.
Floors - The floor is a concrete slab.
rd
Z
0
1
0
M
--I -n
3:
0M
C
M0
0
--I C-)
0 C:
X M
M Z
C —Z
W
0 -n
n
M M
0
0
0 M
C: C/)
C Cn
M 0
Z
Z
Z
0
i
0
M
E,
0
Insulation, structural -
This building is not insulated.
Heat sources -
There are no heat sources in this structure.
Insulation, thermal system -
No TSI's were identified.
Glazing compounds -
Windows were not installed in this building.
Wiring -
Wiring has plastic sheathing.
Doors -
There is no door, only an opening in the exterior wall.
Adhesives -
Adhesives were not found.
Swimming pool
* This is a single piece fiberglass shell (walls & floor).
Functional Spaces
Functional spaces are identified in order to determine a sampling plan which will be representative
of the materials found in areas of similar usage. The functional spaces identified at this location have
been deemed are (nominally):
I Indoor areas
0 Outdoor areas
Suspect Materials
Materials commonly suspected to be ACBM's which were sampled during this inspection are:
M Doors
El Floor coverings
D Insulation, structural
E] Insulation, Thermal System
E] Mastic (adhesive)
Ej Mortar or grout
E] Putty (or caulking)
Roofing
Sealants, coatings or paint
El Siding material
F-1 Vapor barrier membrane
Z Wall & ceiling finishes
E] Wiring insulation
5
Z
0
0
M
Homogeneous Areas
The following chart lists suspect materials identified in order to determine the homogeneity of products
discovered. These are materials which are similar in age, color and texture. This property
contained the following materials which appeared homogeneous:
1 Roofing tar
2 Swimming pool shell
Findings
Materials containing greater than 1% asbestos El were / 0 were not identified.
The following table summarizes suspect materials identified during this inspection.
Characterization of each material as surfacing, TS1 or miscellaneous is made for the express purpose
of developing a sampling strategy and may not accurately reflect the product's designation for
abatement project design purposes.
Succesive layers discovered by the lab are indicated by "a", "b", etc. in the chart Us.
ID
Description
Location
>1%
ACBM
Fri
City
HA
-
FS
Type
A
Roof tar
Pump house roof
N
N
N/A
1
0
mis'c
B
Pool shell
Swimming pool exterior
N
I N
N/A
2
0
Misc
Legend
Abbre
Definition
TS1
Thermal System Insulation
Surf
Surfacing (troweled or sprayed on)
Misc
Miscellaneous
0
Assumed
Abbre
Definition
ACBM
Asbestos Containing Building Material
FS
Functional Space
HA
Homogenous area
Fri
Friable
SITE MAP
t I PUMPI
N shed
(H) --]
Lflouse
220th St SW
E.
Z
0
q
0
M
Ci)
0 M
C
M
0
0
0 C::
-4 K
M M
M Z
K) —i
C
Cn
0 -n
n
M M
0
0
0 M
C Cn
9 Cn
Q 0
Z
Z
CD
Z
0
-1
0
M
Inc.
4MI AWm AV9 N. SGWJO. M qj 103 CHAIN of CUSTODY
Tel. WO.W.0100 gmwl. paW M&3".IM
SAMPLE LOG
I AKWAAAW W&UM
c"m �Awft
Aftwe -5-n2 ALj bil
romi ampin
7w" Nourw TWO t4 O�
r2 5
pi 2-7.o-A,. Ir Sw 3 9
Dava
town addre"
ANT-AWIM5461-9072foc
Air - Kad 0006H 74M 0 7M (WKM4 74M 0 TM We" 0 TEM (EPA Level 11) Othw-
NAmbeebe MIA IN PLM 16) 0pLm(B*"cWm [3PLM(9PA2=ts -0 &A
I mobb I 01hw News
MWALB Lba acu AM I
Taw mobb PPM NAkMw PWI* Clog (AM) I AMWWr
LOW AN 3
M%(P
"�b
8TW 8"bVAA "aft, 0 coppw(cu)
0""ft" Wmim %bw 8*bnkxn
I CtnwAim (Cr) H
RMP*m 8 Waam 0aw 13 RZ"" caftfolb" . 0 Othw (SpeW
M. OW MaidFum s
aim
I ftWWAAW bvi i t t I , I - A '. - 0. k I I 1 1 10-74-W 1 IV I
ft@WW Pond byl OL 1 4-- 1 --1 / - 1:z.
Speebt hk*bVCtkWdl: UnIM,6qUeded IM WON, 0. 9;1 6STMOn VAN b* df$pa"d diwo (2) wee" eft0t ftlWYNis- -r:5
Fle-&-& c- V;Kx -5 .3 .Ld . ae oj%-tk Jr,*C-t-
7
z
0
0
m
--i -n
0 M
c
m 0
0
0
0 C
X M
M Z
0--1
c
3:
0 -n
n
m M
065
0 r-
M
C/)
90)
M C)
Z
r
>
z
-1
X
cl)
z
0
i
0
m
W'.
NVL Laboratories, Inc.
4700 Aumra Me. N, SeWe. WA 95103 0102063
Tel: 20&647.0100, Fox: 2WA34-19N
Bulk Asbestos Fibers Analysis
By POUrbred Light MICIMODPY
Client: Affordable Abstena I, Inc. union IF: 44101DUlamw
Address: 3732 Smith Avenue Client Project t410211C
Evamtt, WA 90201 Samples Received: 2
Aftn0m: Mr. Bill Schroeder Samples Analyzed: 2
Project Location: 0307 - 220th St. SW, Edmonds, gKI20 Method: EPAIODOR-931110
Lmb ID: 2408W94 Client Sample 0: A
Location: 9307 - 22Dth St SW. Edmonds, 98020
Layer I of I D c Ill; ore Black asphaltic material
Non -Fibrous MONNISIS' Ottw Fibrow MaWW8:% AsboMoz Type: %
AWdMnWFIrA Pldlclsl CwkAfte 16% None Detected ND
Lob 10: 24OUS95 Client Umpk 01. 0
Location: 9307 - 22M St. SW. Edmonds, 98020
Lsyw i cg I Dogcripum WhftwUn Wide material with 11brous material
Non -Fibrous Materials: 'bther FIbrous Materials'.% Asbestos Typt. %
Blndwff Hlev,Fine pardtles . .. elm flW4 10% None D*tected ND
Sampled by: Client DMFT
Ana"d by: Steve Zhang' oato Analyzed: 1012202004
W—AmandyndLaIng EpAawRoWM15
Nwk:111 ril we not haMMMUD, INn WI)MY10"Of " wnwenwft wwo a wb- *"w"Y-Allbulk 4
Maillnodwilh Ow bkvft I ""IMMO unwislAm br the -eM
rqzd '(wWtDWOjOMwWd If urnpiewa not Wlb� by HVL pumonneL Own Vw &=MW Of fm mwb 16 ky*Ad by " m@MW*gy Ond awly
a QWhwWr' 7hb Wort OW, r%cA b& (Woduoed WOW In full, wkhatA wmn oppwal of NIA Laboatalws, IM It Oall not be U"d 10 CIRk'M
of Ift GOV
DKdUCtO1Wmrm1 by NVLAper aWaftrqpnw offt LIS (kwfflw*
8
z
0
q
0
M
W
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION -
Footing......................
Wall..........................
Pier/Porch ..................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
Day -dL*/-,
MISCELLANEOUS ..........
FINAL APPROVAL FOR MIS
OCCUPANCY ..................
400e
z
0
1
0
1711