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8017 238TH ST SW.PDF11111111111111 16155 8017 238TH ST SW ADDRESS: Zlz-"/A s�V� TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): Itpq- COVENANTS (RECORDED) FOR: CRITICAL AREAS: d�"-3 DETERMINATION: 0 Conditional Waiver 0 Study Required Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS (OTHER): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: /U/) SHORT PLAT FILE: / / I 2 LOT: BLOCK: SIDE SEWER AS BUILT DATED: H 1Zk SIDE SEWER PERMIT(S) #: z 2 SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD LATEMPTSTsTormAStreet File Checklist.doc Critical Areas Checklist CA File No: 03 -7-0 /Sitenformation (soils/topography/hydrology/vegetation) t� Site Address/Location: � 2� w 2 3. 4. 5: property Tax Account Number. 0 E) A! ('� -0 b I ® 7-1 m 0 Approximate Site Size (acres or square feet): Is this site currently developed? ✓yes; no. T�'� S • /2 If yes; how is site developed? Describe the general site .topography. Check all that apply. Fiat: less than 5-feet elevation change over entire site. Rolling- slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 104,eet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other jplease descnbe): of ear -round standing wafter: /� ; Approx. Depth 6. Site contains areas y 8 7. Site contains areas of seasonal standing water: It ; Approx. Depth . What season(s) of the year? Nd .8. Site is in the floodway �_ floodplain of a water course. 9. Site contains a creek or an area. where water flows across the grounds surface? Flows are year-round? Flows are seasonal? (What time of year? ). 10. Site is primarily: forested ; meadow ; shrubs ; mixed urban landscaped (lawnshrubs etc) II. Obvious wetland is present on site. - Critical Areas Checklist doc13.19.2001 • • • 0 CA File No: Critical Areas Checklist Site Information (soils/ topography/hdrolo /ve etation �y Y gY g ) 1. Site Address/ Location 17 2 Property Tax Account Number: no 4,1719 -Obl Z i " ®f V a- C-C,+ 3. Approximate Site Size (acres or square feet): -7aa . 4. Is this site currently developed? ✓yes; no. % �/� S . F • /z If yes; how is site developed? 5: . Describe the general site.topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontlal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: • Approx. Depth: 7. Site contains areas of seasonal standing water: Approx. Depth: What season(s) of the year? x� 8. Site is in the floodway �_ floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? Flows are seasonal?_ (What time of year? ). 10. Site is primarily: forested : meadow ;shrubs ; mixed d/ urban landscaped (lawnshrubs etc) 11. Obvious wetland is present on site: fi%D94�—:7 QiticW Arms CheckHsLdod3.192AI 0 City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior to his/her submittal of the application to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical areas inventories, maps, or soil surveys). Date Received: `��. 9i �. C9� City Receipt #: I- lv -;5 O Critical Areas File #: -20©3 - = Z( Critical Areas Checklist Fee:— 45.00 Date Mailed to Applicant Ad3 A property owner, or his/her authorized representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please submit a vicinity map, along with the.signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g. site plan, topography map, etc.)'or studies in conjunction with this Checklist to assistant staff in completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable attomey's fees, arising from any action or infraction based in whole or part upon . false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to file s/ppli/cation o :behal a owner as listed below. SIGNATURE OF APPLICANT/AGENT = " v / DATE XZ d Property Owner's Antho ' atio tify By my signature, I cerI e authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for a public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and posting attendant to this application. SIGNATURE OF OWNER PLEASE PRINT CLEARLY Owner/Applicant: Name 2 3 c3 2 Street Address 4; WOA/,e5cit TeleState phone: zip ehone: p Email address (optional): DATE Applicant Representative: Name �72 / Hc;wt7r- 4.�-= '� 0/ Street Address City State Zip Telephone: qZS - ZSZ -Z3Z,6 Email Address (optional): jG1� o4 o4p-br,mil,cov, Critical Areas ChecUisLdoc/3.193001 3`2� tritical Areas Checklist • CA pile No: 0 Site Information (soils/topography/hydrology/vegetation)L✓� (\OL'-" ' 6 1. Site Address Location 7 2 V5 2 Property Tax Account Number: OO 4,0719 -Obl ®Z1. m '), vim.. 3. Approximate Site Size (acres or square feet): -7cr0'. 4. Is this site currently developed? Zyes, no. % ,lo If yes; how is site developed? 5: Describe the general site.topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. — Rolling. slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other jplease describe): 6. Site contains areas of year-round standing water: /� ; Approx. Depth: 7. Site contains areas of seasonal standing water: /A ; Approx. Depth: What season(s) of the year? �f O 8. Site is in the floodway _ �� floodphdn of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? Flows are seasonal? _� (What time of year? ). 10. Site is primarily: forested ; meadow ; shrubs ; mixed urban landscaped (lawn shrubs etc) 11. Obvious wetland is present on site: Oitical Areas C6echHAAIW3.19.2001 City�f Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior to his/her submittal of the application to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical areas inventories, maps, or soil surveys). Date Received: 611 V I C9_�;? City Receipt #: I (Q-,p Critical Areas File #: z_coa — 002 2 Critical Areas Checklist Fee: $45.00 Date Mailed to Applicant: A property owner, or his/her authorized representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please submit a vicinity map, along with the. signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g. site plan, topography map, etc.) or studies in conjunction with this Checklist to assistant staff in completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to file s li/cation o e be e owner as listed below. SIGNATURE OF APPLICANT/AG -r v DATE / Z Property Owner's Autho ' do By my signature, I certify I e authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for a public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and posting attendant to this application. SIGNATURE OF OWNER PLEASE PRINT CLEARLY Owner/Applicant: 0A1 r(H)ozo y O Name r vc . Street Address City State Zip Telephone: Email address (optional): DATE Applicant Representative: Name 1721 Alc;o,0177- A9 Street Address Lc�r q -- 42A J City State Zip Telephone: 1Y 2 S - ZSZ - &-Az J6 Email Address (optional): joh4,P 4 o4st.b,,55¢jl,c w, y Critical Areas Choddist.docJ3.192001 • CA File No: 03 -Z-� tritical Areas Checklist Site. Information (soils/topography/hydrology/vegetation) L d J L . Site Address Location: Vo- &0— + •� 2 Property Tax Account Number: 0O 4,1719 -o b l ® 74 m lD 3. Approximate Site Size (acres or square feet): '70a : I 4. Is this site currently developed? ✓yes; no. % �o S . F . If yes; how is site developed? 5. Describe the general site.topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. Rolling. slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). I . Other (please describe): 6. Site contains areas of year-round standing wafter: Approx. Depth: 7. Site contains areas of seasonal standing water: /lt9 ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway IJO , floodplain of a water course. 9. Site contains a creek or an area where wafter flows across the grounds surface? Flows are year-round? Flows are seasonal?_ (What time of year? ). 10. Site is primarily: forested : meadow ;shrubs :mixed urban landscaped (lawnshrubs etc) 11. Obvious wetland is present on site: 90 p(4:�—:— Critical Areas Checklist doc/3.19.2001 City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior to his/her submittal of the application to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical areas inventories, maps, or soil surveys). Date Received: ` ii 02 City Receipt#:_ G-60 Critical Areas File #: 2 oo3-- c9p2D Critical Areas Checklist Fee: $45.00 Date Mailed to Applicant: 41 —//- 03 A property owner, or his/her authorized representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please submit a vicinity map, along with the. signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g. site plan, topography map, etc.) or studies in conjunction with this Checklist to assistant staff in completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to file ie behal a owner as listed below. SIGNATURE OF APPLICANT/AG DATE Property Owner's Author' do By my signature, I certify I e authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for a public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and posting attendant to this application. SIGNATURE OF OWNER DATE PLEASE PRINT CLEARLY Owner/Applicant: " w `J )/ Name 2 3 (�3 2- Street Address cpkcV4ir5 yt>� f2G Telephone: State Zip p hone: yZS - G q1 S�ilo3 e Email address (optional): Applicant Representative: Name l77, Aa; yol Street Address L6&r cal— A__)/1 City State Zip Telephone: Email Address (optional): )oh ry oGK.6t,-s5a1/,6zK Critical Areas Cheddist dord3.19.2001 The City of Edmonds for SIDE SEWER PER OUTSIDE 0 INSIDE 7 REPAIRS 0 CARD No. ............... . . EASEMENT No. ..........a ..............._. ........... z 0 W.) e CONTRACTOR ............ ..... ............ ...... .. PERMIT No. OWNER ............... y I ........ ... 404."_ .......................................... STREET �F HOUSE No..... ......... e4l..._7 ............ Z.Se .. ?t -kv ............................................ AVENUE LOT No. ...... Z/ ... ..................................... ........... BLOCK No . .................. . ................ ............ fNAME ADD 14 ...................... ........ . . ....... __ ...... .. ......... ............ .......... ....... 0.1 E c u 0 Date Approved: BACKPILL WORK ORDER ISSUED ............................................ DEPOSIT, $ .................... ........ ........................ SEWER WORK ORDER ISSUED .......... .............. ...................... DATE.4... �­.. .3 BY ............. NOTICE: No warranty of accuracy. The information shown on the attached map(s) was compiled for use by the City of Edmonds, its Employees and Consultants. The City of Edmonds does not warrant the accuracy of anything set forth on these map(s). Any person or entity requesting a copy should conduct an independent inquiry regarding the information shown on the map(s), including, but not limited to, the location of any sewer stub shown. Such sewer stubs may or may not exist and may or may not exist at the location shown. Neither the City of Edmonds nor its employees or officers shall be liable for the information given on map(s), nor for any one representation provided based upon said map(s). M E M O R A N D U M November 16, 1987 TO: Ilene Larson Utility Billing Clerk �►� FROM: Bobby Mills �\ Public Works Superintendent SUBJECT: ACCOUNT #507425 Reviewed with Linda the above account. The tenant was notified by a door hanger of the leak. Since this lady is very old, she may have thrown away or did not realize what the door hanger meant. Let's go ahead with the City policy on a leak credit for her account. We will make a standard policy for a letter to be mailed as a follow up to problems such as this. BM/lk #507425/TXTWATER I�• h 0 WA PRINT KEY FROM-Y4 BY USER--IJL250 11/12/87 13.55*26 P- i6 -r-- OF EDMONrkS I.M2011- 1233255 PM Inquire Customer History DETAIL -Customey- Key 13 Customer No* 507425 WYKOM MARIE B NbV I � 1987 PU60U -4ORK'S' 0 i14, OLd No+ 50217500 Tran Descr-iPti-O-n/ Tran Date Sry Date Reading Type Rate Cons Seq Type Amount Ba Lance il 7� 1.1/02/87 10/26/87 000707 1 0001 438 000 1 14o91 Q.6,-11 lk, f 21� * * 11/02/87 10/26/87 00070*7 - 1-2 0001 438- -000- -1- - 22 * 14-- 407*20 11/02/8*7 10/26/87 000707 1-1 0001 438 000 1 385*06 385.06 09/22/87 p 75.61- 09/02/87 -09/02/87 08/26/87-000269. —2-1 0001- 57 0-00-- -1- 14.91, 08/26/87 000269 1-2 0001 57 000 1 3*30 60470 09/02/87 08/26/87 000269 1-1 0001 57 000 1 5*7*40 57.40 07/07/87 — - - P 32*87- 07/02/87 06/24/87 000212 2-1 0001 10 000 1 14#91 32.87 07/02/87 06/24/87 000212 3 . .... 2 0001 10 0.00 1 098 17*96 07/02/87 06/24/87 00023.2 1--1 0001 --10- .0,00.— 1- 16498. 1,6.9P 05/11/87 P 2'7.41--- Due Date TotaL Current 1 2 3 - _ 11/30/e7 422*11 + -*00- 000 ---.00 .3L 31 Cmd2-1' iLL in It L/Sum F re-tuired information and press enter fn Cd6--Cst Rec 12 C(nd4--Cst Sry HeLp 2 CONTINUE 7 = END 2 Cmd5-Src Add Cmd(3--Notes • 41 of 1z, C� CA 0 0 40 -___ -,�:_a41F)f•Ka4ak�taf�4a43434a4•Nra4i4#•1E34)4u••�a494)Fi4a4aE#aE•�a4a4aEa<_94a4:�tK�4)E34#3t�#a434_1F#)Eft#�a4)E#�•143E)<•#aE)4a4afa4aEa4a4i494#•3494><•a4#�a4a4.1434NraE z a4a4 PRINT KEY FROM•—Y4 BY USER—• I Jl..250 11 / 12/97 13 . 55.32 X.* a4a4 a4a4a4a434a4a4a4a�a4•�4a4a4a4a4a4a4aca4a4a4•�4•x•a4a4a4•�4•�4a4•ua4•�4xa4u•xa4x•a4xa4a4a4a4a4�a4a4a4a4a4><•aca4a4a4a4a4a4a4a4a4�•xa4a4a4�a4a4a4a4a4a4a4a4a4a4a4•�4•�4a4a4a4 �s 1.1/12/87 CITY OF EDMONDS UB2011 - - 1:33*#55 PM Inquire Customer Notes 13 Customer No . 507425 WYKOM MARIE $ _ See Date N,Qte . 000 08% ?6/f37 CREEP T/N 1F l• 2: 3_ _ Ro L L UP - - - - - - -- - - -- - 31 Ro L L Dn End of Fi I.e leached Cmd3—Ind. Srn 1 = CHANGE 2 = CONTINUE 4 DELETE 7 = END 2 35 7: ]7 r ?5 a' I • .TTC « i �o _ -♦ . •'wP - `r.ry, Y•' ;. s n+a- - Av" 7^w1 ;P^ f v„ �4:` 7.;X .,T .1 •.•..-,.s+r'C .. .. �•.� City of Edmonds -Permit No: 8Z RIGHT. O ' -WAY, CONSTRUCTION PERMIT Issue Date: 3/0 02 A. Address or Vicinity of Construction: 1-? +h ST. S • W. C 1)1L&o 11� S r l'J A V' 02.E B. Type of Work (be specific): U Q 1 `{ 1" C C� LU1, M0 Cat 12 't) U O %Z AAA-tL r ay tJw i ._ 5LSE NTTara111 C. Contractor: "178-09' q Mailing Address: 61 t 7- 2 6 State License #: LA P, L 60 1 ;g , c Cd'j Auv b tL XL 50' 4+ D. Building Permit # (if applicable): f Contact: 5Lr:1= Qe -/ 22 Phone: Vl�-4-4IE A2S-1 v - 2fd2�j Liability Insurance: Bond: $ Side Sewer Permit # (if applicable • E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ EUC (PUD, VERIZON, PSE, AT& T, OVWD) Multi -Family ❑ Single Family ❑ Other INSPECTOR: F. PAVEMENT CUT: ❑ YES 59 NO G. SIZE OF CUT X CONCRETE CUT: ❑ YES [;.NO Al'I'LICANTTO REAI) AND SIGN INDEMNITY. Applicant understands by his/her signature to this application he/she holds the City of Edmonds harmless from injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. ♦ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every "flagger:..must be trained as required by (WAC) 296-155-305 and must have certification, verifying completion of the required training in their possession. ♦ Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City - approved material prior to the end of the workday - NO EXCEPTIONS. ♦ Three sets of construction drawings of proposed work are required with the permit application. . S CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK ' I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNO.WLED.GE THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS Signature: _ a gn!- •s .10 ohf"_ :66 Date: f —,/- a 2-. (Contractor or Agent) FOO&ITY USE ONLY Approved by: Right -of --way Fee: 3 , 4 S <% Time Authorized: Void After Disruption Fee/Fund 111: Special Conditions: 1 Ns'rpru aaluk) OF '9vX Restoration Fee: V_ "PRNW Pl f-iNf It WF-OOL OF- _Fos( Total Fee#79 ( WOF : A61+I� 6r- I - R) 1?9- 9 TG Receipt No:19(1$ I fL :1-ct1. S'Cii11C15 Issued b-^tf'i�� UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS COMMUNITY DEVELOPMENT CODE (Pho eC425-771-0220, Ext. 132 ) FINAL APPROVAL OF PERMITTED WORK: DATE: ` Insp ctor's Signature For inspection requirements see Engineering Inspection Information handout. •4 DA My DocumentsTormAEngnTp ROWpermit_.doc 4 \CS C Oki, 7wc) 9 if'U /cs wS ftf'. NOT ,f pit MMOD -c Be, 7FLXE� r1l'TFt-�(J --Ic /�O c kS Page 1 of 1 < �STA("` "' OD", uN f'ili'ED .�..c we Far' SalesfSUpport; calI 1=800-229-4500 Your Shopping Cut Is Empty = ' � Type II Cluster Box, 12 Door (1 Parcel Locker & Pedestal °AUtomatlon Products This. -product Officially Certified and Approved by the Us Postal service! The Cluster Box Units (CBU) offer s a_high level of, security in an easy -to -use, attractive freestanding unit. Constructed of all stainless steel alu resistant components, the CBU is designed for use throughout the US in all weather conditions. Available in CBU.has a parcel locker equipped with a USPS 306P lock and an outgoing mail slot. Mail carriers can gain e slots through front entry master door gates hinged on the outer corners of the cluster box units. Pedestal p added to adapt to today's growing home parcel deliveries. Cluster Box Units feature tough .1".thick welded outer cabinet, which is scratch and corrosion resistant. Stainless steel hardware and hinges withstand all we will not rust. Units available only as pictured. Lead. -time is 1-2 weeks, Free freight on orders of 6 or more. Bolt Layout"I—i i.s 0, 0 •r liti it SL t: i t. ., nt i.:-;a i-, .a .a ..`CC :.tai.-( _.i..',liyt: t. All icin alread reflects the NOA or Special Discount for each pr Pre -Inked and Rubber Stama U.— "`;`�,I .�-i' ' ' -`z" 'a".v. Pr g y W�Promotional Products ,. _ , ,. ,.,-. You must ADD the NOA or Special % to the prices listed on -screen. i6ural Products The discount percentages reflected in the quantity price breakdowns are for Postal Officials Only Service 1Nindow Products i Si na e. Topeka-MQQ Program _ iiVA al Comm. Boards Product Wght Wholesale Qty Price Code �:tOrder Form 115 Ibs. -50% ii�Credrt_p lication r1 N1004637 $1,146.60 :Catalog lli -i in JI Ictr i-icti:E ;ii4Newslet er Teu A Fnend I Add t0 Cart. CEmolovment ASite Index ;4 auster Box .5Z Cluster Box Units i The Cluster Box Units (CBU) offer superior durability and a high level of security in an easy to- use, - - — and corrosion resistant attractive freestanding unit. Constructed of all stainless steel aluminum components, the CBU is designed for use throughout the U.S. in all weather conditions. Available — in three sizes. Each CBU has a parcel locker equipped with a USPS 306P lock and an outgoing I st 2 :? t0 mail slot. Mad carriers can gain easy access to all mail slots through front entry master dour gates r — hinged the outer corners of the cluster box unit:. Pedestal parcel units can be added to adapt V 3, on I to today's growing home parcel deliveries. S Standard Features _ Cluster Box Units feature tough .1" thick welded aluminum protective outer cabinet which is ` I _ _- _ . scratch and corrosion -resistant. Stainless steei hardware and hinges withstand all weather • -" "a"6"' _� conditions and will not rust. Doors are constructed of .125'•.25" thick aluminum and feature 16 5-pin cam locks with spring loaded cover and quick -release door lock latch. Units available only _i c . as pictr,ied. hrr• 4 d�1 �" J -- Fostoi Froducrs un,rrnec. lac .nas•oe. pod ;- S^ • moiibox iMgoiicron ner`.•cli% it `/cu c'? Intet25red -, (J •g4 ' in portici mrlq end •.vou:� :a:e ro be oddeb ro our - - '---- -"-- -"- -- - - �nuteni'lig, pieo-- r tali BC&':2V-a:CO and speoit -• - to o Cuvomet :ernca ilrprezenrcrjve "KC d-4- T E f %4-1-cl�„ - N10 44637 _.� Type II ' Pricing includes pedestals. If your pedestal is W existing P damaged, call for replacement Ib components/parts. I' f• „�t ` Lh. ... ...ill i. lu « N1004638 r I' Type 111 ;:i., _... C r.ailri, t. Order Toll Free 1-800-229-4500 U.S.Ps. Ap�•r, ure-1 This L` Product ii .. Mid Snips —freiylit_ For Pricing See Next Page. tnrvirw.postalproducts.com dl!t,in I t �i pecials ot(t�e web at Fax 1-800-570-0007 POSTMASTER EDMONDS POST OFFICE UNITED STATES POSTAL SERVICE March 7, 2002 Planning Department City of Edmonds Edmonds, WA 98020 Permit Coordinator: RECEIVE® MAR - 8 2002 PERMIT COUNTER This is to confirm that the Postal Service has approved the request by residents of the 8000 block on the 238`' St SW to convert their mail delivery from curb side mail boxes to a locking Cluster Box Unit. We have approved the location to be immediately adjacent and to the east of the current mailbox stand at 8017 2381h St SW, Edmonds, WA 98026. We have reviewed the site and find that there is sufficient space for the postal vehicle to pull off the road to affect a safe delivery of the mail. If you have any further questions you may call Jim Sutliff, Manager, Customer Services (425) 670-2710. Sincerely, X'-Ok a, Thomas M. Snyder Postmaster 201 MAIN ST EDMONDS, WA 98020-9998 1(800)ASK-USPS FAx: $b1-7 2 Sw 1N\V111 L A &8 S ++wrweoovs eurnu►�s se�ev+os Asbestos Survey 8017 238th _Street SW Edmonds, WA Date Prepared April 21, 2003 Prepared for. Tony DlPangrazlo 23632 Hwy 99, PMB F-506. Edmonds, WA 98026.9206 Prepared By: John Terrill Building Inspector Cart* 1004060 Expiratlon Date:. February 4, 2004 Date Inspected: Aprll 14, 2003 Project #: 2003-175 TABLE OF CONTENTS Subject Page 1.0 SCOPE OF WORK 1 2.0 SURVEY METHOD 2 3.0 LABORATORY INFORMATION 3 4.0 BUILDING DESCRIPTION 4 6.0 FINDINGS 5-6 6.0 CONCLUSIONS AND RECOMMENDATIONS 7-8 7.0 LIMITATIONS OF SURVEY 9 APPENDICES Sample Locations (Map) A Laboratory Results B AHERA Certifications S Laboratory qualifications C 1.0 SCOPE OF WORK An investigative survey for asbestos containing materials (ACM) was conducted on a residential structure located at 8017 238th Street SW, Edmonds, WA. The Inspection was conducted on April 14, 2003 by John Terrill, an AHERA certified building inspector. This inspection was performed at the request of Tony DiPangrazio, property owner. The purpose of this Inspection was to identify asbestos containing materials that would be impacted by the planned demolition of this structure. The asbestos survey section is written to comply with the AHERA asbestos sampling procedure as stated in 40 CFR 763.86. This protocol is required for all asbestos surveys prior to a building demolition under the Puget Sound Clean Air Agency, (PSCAA), Regulation 111, Article IV, revised July 13, 2000. The asbestos survey also satisfies the "Good Faith" asbestos inspection requirements as stated in Washington Administrative Code (WAC) 29"2-07221(2), "identification". As stated In this regulation, the owner of a structure scheduled to be renovation/demolished must provide a contractor with a written report of the asbestos containing materials to be disturbed during renovation/demolition. The National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61 requires a survey by an accredited asbestos inspector prior to demolition of a structure. A floor sketch indicating sampling locations has been included in Appendix A. 8017 238th Street SW, Edmonds, WA Projed # 2003-178 2.0 SURVEY METHOD Asbestos Survey Method A walk-through Inspection of all accessible areas of this structure was performed to identify Potential asbestos -containing materials. The walk-through inspection Included a review of the Internal and extemal aspects of this structure. The locations and types of potential asbestos containing materials were noted. Sufficient bulk samples of building materials (vinyl floor tile, roofing, wall materials, etc.) were obtained of each. material to satisfy the requirements of the Asbestos Hazard Emergency Response Act (AHERA) rules and regulations. These samples were placed Into plastic sample bags, numbered and recorded. Homogeneous Materials Homogeneous materials are defined as an area of Asbestos -Containing Material (ACM) or Presumed Asbestos -Containing Material (PACM) which appears similar throughout in terms of color, texture. and date of material application. The report listing for homogenous materials will appear as follows: Sample Number —Description Material Location Asbestos % Area Friable es1no b#-01-01 white fkoortile kitchen ob#-01-02 white floor tale kitchen b#-01-03 white floor the I kitchen Under OSHA Guidelines, a minimum of three negative analysis of a single suspect homogeneous asbestos containing material is required to prove a negative result for surfacing materials and thermal system Insulation. NVL Laboratories, Inc., Page 2 4708 Aurora Avenue North, Seattle. WA 981 o3 ow% mnRN amni nn . Fv ronai aam_i ova 8017 238th Street SW, Edmonds, WA Project 0 2003-175 3.0 LABORATORY INFORMATION Laboratory Analysis — Asbestos Samples are analyzed in our laboratory using polarized light microscopy (PLM) with dispersion staining. If samples are not homogeneous. then subsamples of the components were analyzed separately. All Bulk samples are analyzed using EPA Method 600/R-9311 16 with the following measurement uncertainties for reported 96 Asbestos (1 °,6=0-3%, 5%.> 1-9g6, 10%=5-15°,6, 2096=10-30%. 50%=40-s0%). For samples containing more than one separable layer of materials, the report will include findings for each isyer (labeled Layer. 1, Layer. 2, etc.). The asbestos concentration in the sample Is deterrrdned by visual estimation. Laboratory Accreditation. Professional accreditations for NVL Laboratories, Inc., include the hollowing: NVL Laboratories, Inc., is currently accredited by the National Institute of Standards and Technology (NISI) under the National Vdunteer Laboratory Accreditation Program (NVLAP) program for bulk asbestos fiber analysis. NVLAP Lab Code 102063-0. NVL Laboratories, Inc., Is approved by the American Industrial Hygiene Association (A1HA) Asbestos Analysts Registry (AAR) program for airborne asbestos fiber analysis. Counter ID 7412. NVL Laboratories, Inc., is currently accredited by the American Industrial Hygiene Association (AIHA) under the Industrial Hygiene Laboratory Accreditation Program (IHLAP). The IHLAP Program is designed specifically for laboratories Involved in analyzing samples to evaluate workplace exposure. Certification Number 563. NVL Laboratories, Inc., Page 3 4708 Aurora Avenue North, Seattle, WA 98103 o►. r7na% Pu7_ninn . =� rrynal azn_�oza 8017 238th Street SW, Edmonds, WA Project # 2003-175 4.0 . BUILDING DESCRIPTION General Building type: This is a single story, wood framed, single-family residence with a full partially finished basement. Primary external components: The primary external component is wood siding. Type of foundation: The house Is constructed on a full, partially below grade, concrete basement, Roofing materials: Roofing Is asphalt shingles. Window types: Windows are wood framed with glazing compounds. Flooring: Flooring is primarily hardwood. There is sheet vinyl in the kitchen and bathrooms. Thermal systems w/insulation types: There is a forced air heating system without suspect thermal insulation. Finishing: Partitions, walls, and lids are gypsum wallboard. NVL Laboratories, Inc., paGle 4 4708 Aurora Avenue North, Seattle, WA 98103 Ph SA7-nlfn I . =v /9Aa% R4A_104Q 8017 238th Street sW, Edmonds, WA Project # 2003-175 5.0 FINDINGS Inventory of Suspect Asbestos -Containing Materials Sample 2003-175 1 1: sheet vinyl flooring back entrance in 1: NO -1-1 2: fibrous basement 2: NO backinalmastic Area 2003-175 1: sheet vinyl flooring back entrance in 1: NO -1-2 2: fibrous basement 2: NO backing/mastic 2003-175 brick/mortar main chimney NO -2-1 2003-176 1: sheet vinyl flooring kitchen flooring 1: NO -3-1 2: fibrous 2: NO 3: sheet vinyl flooring 3: NO 4: fibrous 4: ND Wicking/mastic 5: linoleum 5: NO 6: fibrous backing 6: NO 2003-175 1: sheet vinyl flooring kitchen flooring 1: NO -3-2 2: fibrous 2: NO 3: sheet vinyl flooring 3: NO 4: fibrous 4: ND backing/mastic 5: linoleum 5: NO 6: fibrous backing 6: ND 2003-175 1: sheet vinyl flooring bathroom flooring F 1: ND -4-1 2: fibrous 2: ND 3: sheet vinyl flooring 3: NO 4: fibrous 4: NO backing/mastic 5: felt backing NO 2003-176 1: sheet vinyl flooring bathroom flooring .5: 1: ND -4-2 2: fibrous 2: NO 3: sheet vinyl flooring 3: NO 4: fibrous . 4: NO backing/mastic 5: fell backing 5: NO ND - Nena f]wtartorl This material Is less than 1% asbestos if if Is considered as a component of the composited sample, Pleaes refer to the end of the next section for information on materials containing less than % asbestos. NVL Laboratories, Inc., Page 5 4708 Aurora Avenue North, Seattle, WA 98103 DM /7nm "7-ninn . =v Ong1 AU-10QR 8017 238th Street SW, Edmonds. WA Protect # 2003.175 Sample Matariai Location Asbestos Area Friable Number Description % W slno 2003-175 splash guardfadhesive around kitchen NO -5-1 counter 2003-175 splash guardfadhesive around bathroom NO -8-1 shower 2003-175 1: paint living room wall 1: NO not -7-1 2: joint compound 2: 2• quantified no 3*._,gypsum wallboard 3: ND 2003-175 '1: paint north bedroom wall 1: ND 7-2 2: Joint compound 2: 2• 2003.175 1: painUjoint compound south bedroom wall 1: 2• 7-3 2: joint compound 2: 2• 3: aymm wallboard 3: NO 2003-175 window glazing laundry room window NO -8-1 compound 2003-175 thermal insulation attic crawl space NO -9-1 batting 2003-175 thermal insulation attic crawl space NO -9-2 batting 2003-175 1: thermal Insulation attic crawl space 1: NO -9-3 batting 2: residual roofing fait 2: NO 2003.175 1: roof shingles rooftop 1: NO -10-1 2: roofinq felt 2: NO 2003-175 1: roof shingles rooftop 1: NO -10-2 2: roofing felt 2: NO 2003-175 vapor barter underneath exterior NO siding 1-11-1 2003-175 vapor barrier undemeath exterior NO -11-2 siding NO - Nor @ Detected • This material is less than 1 % asbestos if it is Considered as a component of the composited sample. Please refer to the end of the next section for Information on materials containing less than % asbestos. Any suspect material(s) not Identified above should not be disturbed, and tasted Immediately. The suspect material must be treated as asbestos containing until testing proves otherwise. NVL Laboratories, Inc., Page 6 4708 Aurora Avenue North, Seattle, WA 98103 oti mnm FA7.nim . r-w t,)nn% azn_1 oza W17 238th Street 3W, Edmonds, WA Projed IN 2003.176 6.0 CONCLUSIONS AND RECOMMENDATIONS ASBESTOS The following summarizes the homogeneous Asbestos -Containing Materials (ACM) and Presumed Asbestos -Containing Materials (PACM) Identified at the residential structure located at 8017 238th Street SW, Edmonds, WA on April 14, 2003. I. Joint Compound: (material number 2003-175-7) There Is an undetermined quantity of asbestos-contalning joint compound associated with the gypsum wallboard system throughout the stnrctum-, This material is less than 1% if it is considered as a component of the wall system. Please refer to the end of this section for information on materials containing less than 1% asbestos. Approximations of square footage are offered as an added service to the client. These numbers are not exact values and should be confirmed by the client and participating contractors. If discovered, all ACMs that will be disturbed as a natural part of renovation/demolition and are required to be removed and disposed of In scconiance with Washington State Regulations. Washington State Department of Labor and Industries and PSCAA require that the abatement be performed using Certified Asbestos Workers under the direct on -site supervision of a Certified Asbestos Supervisor. Further, NVL suggests that an AHERA inspector review this Property after abatement to ensure all ACM has been removed by the contractor. Hidden wall and ceiling cavities that are not accessible during the time of surveying can sometimes conceal ACM. Thus, NVL recommends that an AHERA inspector/project manager be on site at the time of renovation/demolition to ensure that any potentially asbestos - containing materials uncovered during the process of renovatkwvdemolition be dealt with properly. NVL Laboratories, Inc., Page 7 4708 Aurora Avenus North, Seattle. WA ID8103 DID l )Alt% 447-ninn . V. I MAN a14-401A 8017 236th Street $W. Edmonds, WA Project # 2003-175 Materials Containing 1 % Asbestos or Less The OSHA asbestos standard(s) regulate occupational exposure to asbestos, including asbestos containing material (ACM). Please see (a) Scope and Application and (b) Definitions for `Asbestos" and "Asbestos Containing Material,` for the General Industry. Construction and Shipyard asbestos standards. in the OSHA Construction Standard, work Involving materials containing 1 % or less asbestos would be considered unclassified. Unclassified asbestos operations cover employees likely to be exposed In excess of the permissible exposure limit (PELs), and who are performing operations not covered by Class I through IV. For construction work involving unclassified asbestos the applicable requirement will include; an exposure assessment, use of vacuum cleaners equipped with HEPA fitters, use of wet methods and prompt cleanup of debris, use of respirators. and protective clothing, training and record keephg. Further, If a negative exposure assessment cannot be made, air monitoring would be required as part of the exposure assessment. NVL Laboratories, Inc., Page 8 4708 Aurora Avenue North, Seattle, WA 98103 Ph /9ARl rA7-ninn . cv r9na► R,%A_icaR 8017 238th Street SW, Edmonds, WA Project# 2OM175 7.0 . LIMITATIONS OF SURVEY The sole purpose of this survey report is to document asbestos -containing materials discovered in the survey of suspect materials by NVL Laboratories personnel at the residential structure located at 8017 238th Street SW, Edmonds, WA on April 14. 2003. This site visit consisted of a thorough visual walk-through of the building for the purpose of viewing and sampling potential ACMs. As hazardous material surveys are non -comprehensive by nature, NVL Laboratories, Ina, cannot be held liable for materials which require destructive means to access, materials which are hidden from sight (e.g. materials hidden behind walls), materials which cannot be found due to their obscure nature, or which otherwise cannot be discovered with reasonable diligence. This document is the sole property of NVL Laboratories and the property owner, or his agent, authorizing this survey. Inspecteg by: ,� John Terrill AHERA Building Inspector AHERA Certificatlon No.: 1004ASO AHERA Certification Expires on: February 4, 2004 NVL Laboratories, Inc., Page 9 4708 Aurora Avenue North. Seattle, WA 98103 Ph MA% aA7-ninn . o., imm aae_,oaa "b""'y `' "" FUUET SOUND CLEAN AIR AGENCY Date Received - i 110 Union Street, Suite 500 3 : N :; Seattle, WA 98101-2038 RECEIVED www.pscleanair.org 200, 00690 ___...... __ NOTICE OF y JUL I 5 \. Proiect Tyne: '1 ❑ Friable Asbestos Removal 2 ❑ Friable Asbestos Removal & Demolition 3. Demolition Only. I. Property Owner: TOM LIP. ,Id6 ;L Phone - •.3 j�,f/c Aailing Address: 13E;' — City: - Zi .�& State Asbestos PLEIS PR1MC RLY. ! IYl[1 11� R R RN.HA/LlVG B Contractor: UU Owner/CEONt:.. lailin , . (i -5 atractor Address: Phone: , %0. Job No.: :ity: State: Zip:R�P7. ��• Fax: I. Site -Address:.. Q... 7 S 7__. - - -- Site t Gt/ Zi p' Manager: —rON aZaS-.r/','2- �'+ 63 rell '� Local Phone: <_ Asbestos Survey or No. of Date of Asbestos Was Friable Asbestos Identified? Yes o ❑ Mat'! Presumed Structures: Serve : d 3 Was Nonfriable Asbestos Identified?, ❑Yes 9ivo HERA Building NIIL S Certification #: 140Y-060 Attach a copy of the sure unless Inspector: L" " ]''err-'! Ex . Date: � - � - p ' is identified. �' friable asbestos I AHERA Survey is required before all demolition projects _ Demolition Start No. of I. Training Fire (List Fire Dept.) Information: Date: Structures: 2. ❑ Ordered Demolition attach co of Order Demolition ZgPrtlleCrtoliti_og coA gro mail addres back Will nonfriable asbestos be left in lace during demo? yes Contractor /� �3YY ju1�c/ ,I�1/� FXcv�77i= B.y� � type and qty. P g No . Friable Asbestos N Work Days: M T W ,Th F Sa Su Project Informatio Start Date: Completion Date: Hours: ttal Qty. to be Removed: Linear Ft Will all friable asbestos ❑ yes st type(s) of material to be removed: S uare Ft. materials be removed? ❑ No Asbestos/Demolition Project Categories: Notification Period Project Demolition Single -Family Residence: �. ❑ Asbestos Removal Project Only Fee Surchar¢e A. Prior Notice A. $25 I. ❑ Demolition Project (with or without asbestos removal project) B. 10 Days' B. $50 "(Asbestos removal can begin upon notification; demolition must wait 10 days) ite: If floe single family residence is owned by one family who has been or will be using the residence as their domicile, the above boxes I or IB may be checked A single fam# residence does not include rental roe multi- amil units, or an fnMd-use build All Other Demolitions With No Asbestos Removal Project Friable Asbestos Projects other than Single FamilyResidence : $200 > 10 - 259 linear feet or � 48 - 159 square feet of asbestos 260 - 999 linear feet or 160 - 4.999 square feet of asbestosLJ iov$1,000. $SO 1.000 - 9.999 linear feet or 5,000 - 49 999 s uare feet of asbestos $100 > 10,000 linear feet or > 50,000 square feet of asbestosCl $250 Ll Emergency Asbestos Project or Emergency Demolition Project (Single-FamilyResidences are exempt from Prior Notice Twice Project Fee fee; however, owners must provide a written cTergency Muest) I certify that the information contained in this notification & supplemental data is, to the best of my knowledge, accurate & complete. enC A Use On] g y. Si nat -- — Represents— ngDate Reviewed By et Sound Clean Air Agency Form No.: 6&160 (Revised 3/03) TS n The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos: project involving materials equal to or greater in size than 10 linear feet or 48 square 'feet and for all demolition projects (regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. der no removal .and deolition projects involving materials and structures below the notification threshold are still subject to all other requirements of Regulation III Article 4. After receiving a complete notification with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and demolition contractor by mail. The returned copy will be your validated notification. J. Demolition v Mailing Address: I Phone: I Contractor's Job #: Fax: GUIDELINES FOR SUBMITTING ARASBESTOSIDEMOLITION NOTIFICATION Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring, cement. _. asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing materials. Step 2. Enter property owner information in Box B. Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential project, in Box C. Print clearly this is your return mailing label. Step 4. Enter the site address for all notifications in Box D. For multi -structure projects, attach supplemental sheet with.a site.map (include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure. Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the notification of a demolition project when only nonfriable asbestos or no asbestos is identified on the survey. Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire requirements are contained in Regulation I, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition, check yes and list the type and quantity of material. Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as popcorn ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc. Step 8. For Single -Family Residential projects; check BOX H1A for renovation projects, BOX HIB for demolition projects with or witlJ.-t_asbestos removal._Asbestos removal -may -be conducted after a complete notification is received, but demolition activities can " only begin on the 10`s day after the notification is received. Note. If the single family residence is owned by one family who has been or will be using the residence as their domicile, boxes lA or 1B may be checked A single family residence does not Include rental property, multi family units, or any mixed -use building. For Commercial asbestos projects (or projects that do ,not qualify as Single Family Residential); check the project category H2 - 6 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge ;additional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box 1 - 6 and the applicable emergency box in HT All emergency requests must be accompanied by a letter from the property owner demonstrating the aged to conduct the project immediately in accordance with the requirements in Regulation IIISection 4.03 (c) 3tep 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box I. Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for work schedule changes if the contractor is participating in the Agency work schedule fax program A $25.00 processing fee is required .`or all amendments. ?uget Sound Clean Air Agency asbestos regulations and forms can downloaded from the Agency web page at www.pscleanair.org. ?or technical assistance contact (206) 689-4058 and for administrative inquiries contact (206) 689-4090. , 'ueet Sound Clean Air Aeencv Fnrm Nn • AA_I Fn iR.v;c-i tint) rc 200300690 PUUET SOUND CLEAN AIR AGENCY 110. Union Street, Suite 500 Seattle, WA 98101-2038 www.pscleanair.org NOTICE OF INTENT Date Received RECEIVED a 15 2003 rur .. -- \. Proiect Tyne: 1 ❑ Friable Asbestos Removal 2 ❑ Friable Asbest- Removal & Demolition 3 Demolition Only 3. Property Owner: 7701a Phone: ygS-C.,eiti-Scxi; ? i�a vC Qailin Address: 3C, 1 Asbestos PU i PR/M C Rr r.THUS WYU Contractor: - city: Ine YOUR RETURN WILING L--bl VokW State fit/ Zi :yNQ.2.6 G lu IrAd IV Owner/CEO:.. 4ailing Address: Phone: ��• 3 ntractor • Job No.: :i State: Zi RCPT. ��• Fax: I. Site -Address: 0 t 'Ali' Gt/ - Zi p2 Site . Manager: -ro/q oZ� - �/''.?- �663 c-&// Local Phone: 5- 6 Asbestos Surveyor A�o.o Mat'l Presumed : � c Date of Asbestos Survey: �f d3 Was Friable Asbestos Identified? Yes o HERA Building 1V UL S Was Nonfriable Asbestos Identified?. ❑Yes to Inspector: J- - Certification #: /00Y-060 Attach a copy of the survey unless friable asbestos ri cam..'! Ex , Date: y4 - p j4 is identified. 1 AHERA Survey is required before all demolition vroiects Demolition Start Information: Date: Demolition 44ag y Contractor•._.. . Friable Asbestos N Project Informatio Start Date: )tal Qty. to be Removed: St type(s) of material to be removed: Linear Ft. No. of 1. U Training Fire (List Fire Dept.) Structures: 2. ❑ Ordered Demolition attach co .of Order *.. Will non ble asbestos be left in place during demo? Yes . No If yes, list type and qty. Work Days: MT W Th F Sa Su Date: Hours: Will all friable asbestos ❑ Yes - Square Ft. rrmft- inle ha n -- Asbestos/Demolition Project Categories: Single -Family Residence: Norificarion Period o Prject Demolition k. ❑ Asbestos Removal Project Only Fee Surchare 1. ❑ Demolition Project (with or without asbestos A. Prior Notice A. $25 removal *(Asbestos removal can begin on notification; demolition wait 10 days)B. 10 Days* B. $50 Ite: If the single family residence is owned by one family who has been or wX be using the residence as their domicile, the above boxes 1 or IB may be checked A single family residence does not Include , rental prop -21 All Other Demolitions With No Asbestos Removal Project multi am units, or an mixed -use build' WWI Friable Asbestos Projects other than Single Family Residence : 10 Days Asbestos Demo S200 LJ >_ 10 - 259 linear feet or >_ 48 - 159 square feet of asbestos 2 00 - 999 linear feet or 160 - 4,999 feet of asbestos Prior Notice 10 Days $150 $50 1.000 - 9.999 linear feet or 5,000 - 49 999 s uare feet of asbestos 10 Da 10 Days $300 $100 LJ > 10,000 linear feet or > 50,000 s uare feet of asbestos 10 Da $750 $250 Emergency Asbestos Project or U Emergency Demolition Project Prior Notice $2,000 $1,000 (Single -Family Residences are exempt from emerttencv fee- hnwrv" ,,..,......,,,.....� _..--_—_-'- •-_ Twice Project Fee 1 certify that the information contained in this notification & supplemental data is, to the best of my knowledge, accurate & complete. I- zwe _'7 L623. Representing Date Agency Use 0n1 -�' Reviewrd By et Sound Clean Air Agency Form No.:.66-160 (Revised 3/03) TS The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects (regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. Asbestos removal and demolition projects involving materials and structures below the notification threshold are still subiect to all other requirements of Regulation III Article 4. . After receiving a complete notification with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and demolition contractor by mail. The returned copy will be your validated notification. I Demolition Mailing Address: Phone: Contractor's Job a: City, JState: Zip: Fax: GUIDELINES FOR SUBMITTING AN-ASBESTOSWEMOLITION NOTIFICATION Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring, cement. _ asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing materials. Step 2. Enter property owner information in Box B. Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential project, in Box C. Print clearly this is your return mailing label. Step 4. Enter the site address for all notifications in Box D. For multi -structure projects, attach supplemental sheet with a site map (include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure. Step S. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the notification of a demolition oroiect when only nonfriable asbestos or no asbestos is identified on the survey. Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire requirements are contained in Regulation I, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition, check yes and list the type and quantity of material. Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as popcorn ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc. Step 8. For Single -Family Residential projects; check BOX H1A for renovation projects, BOX HI for demolition projects with or wit-bQut asbestos .remoxal._'Asbestos removal -may -be conducted after a complete notification -is received, but demolitiou activities can ---- only begin on the 10`s day after the notification is received. Note. If the single family residence is owned by one family who has been or will be using the residence as their domicile, boxes lA or IB may be checked A single family residence does not include rental property, multi family units, or any mixed -use building. For Commercial asbestos projects (or projects that do not qualify as Single Family Residential); check the project category H2 - 5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge ,additional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box 1 — 6 and the applicable emergency box in H7. All emergency requests must be accompanied by a letter from the oroperty owner demonstrating, the aced to conduct the project immediately in accordance with the requirements in Regulation III Section 4.03 (c) 3tep 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box I. Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for work schedule changes if the contractor is participating in the Agency work schedule fax program A $25.00 processing fee is required 'or all amendments. ?uget Sound Clean Air Agency asbestos regulations and forinkcan downloaded from the Agency web page at www.pscleanair.org. ?or technical assistance contact (206) 6894058 and for administrative inquiries contact (206) 6894090. 'ueet Sound Clean Air Aeencv Fnrm Nn - A(,_ I Fn mR ;c—i IMIN Tc