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HomeMy WebLinkAbout314 N French Ave_BLD2927_2026 �` -- CITY OF ARLINGTON 238 N. OLYMPIC AVE - ARLINGTON, WA. 98223 PHONE; (360) 403-3551 BUILDING PERMIT Address:314 N French Ave Permit#:2927 Parcel#:00529900400600 Valuation:4000.00 OWNER APPLICANT CONTRACTOR Name:GCGC INVESTMENTS LLC Name:[Company Name] Name:Crakar Contracting Address:21705 88TH DR NE Address:[Company Address] Address:5327 141st PL NW City,State Zip:ARLINGTON,WA 98223-8940 City,State Zip:Stanwood,WA 98292 City,State Zip:Stanwood,WA 98292 Phone: Phone:360-631-2500 Phone:360-631-2500 LIC:CRAKAC*814L5 EXP:06/25/2021 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Demolition CODE YEAR: 2015 STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION 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 WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC110/�IRC110. E CE SSalcs x relating to construction a nSTiction materials in the City of Arlington must be reported on your sales tax return form and cod i C't f Arli 101. (?//4t//f ��y ignature Print Name Da c Relcala By atc CONDITIONS Existing Side Sewer will need to be capped at the property line or where the 4" X 6" transition fitting is found. Contact the Wastewater Department at 360-403-3508 for inspections 24 hours in advance. Contact Water Department at 360-403-3542 prior to demo for water meter removal. Approved job copy shall be onsite for inspections; if applicable. Call for final inspection. 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 FEES Date Description Fee Amount 12/11/2019 Demolition Fee $100.00 12/11/2019 Processing/Technology Fee $25.00 12/11/2019 State Building Code Surcharge Fee $6.50 Total Due: $131.50 Total Payment: $0.00 Balance Due: $131.50 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon e �I 1 r t 1 Permit#: 2927 Permit Date: 12/09/19 Project Name: Chase Demo Site Address: 314 N French Ave Company/Applicant Name: Crakar Contracting Company/Applicant Address: 5327 141 st PL NW City, State, Zip: Stanwood, WA 98292 Contact: Craig Chase Phone: 360-631-2500 Email: crakarcontracting@gmail.com Permit Type: Demolition Valuation: 4000.00 Square Feet: 0 Number of Stories: 0 Type of Construction: Occupancy Type: Proposed Use: Demo of existing SFR MIC/Opportunity Zone: Permit Issued: Permit Expires: DNU: Status: IN PROCESS Property Parcel# Address Legal Description Owner Name Owner Phone Zoning GCGC 111 Single Family 00529900400600 314 N FRENCH AVE INVESTMENTS Residence- LLC Detached Contractors Contractor Primary Contact Phone Address Contractor Type License License# Crakar Contracting Craig Chase 360-631-2500 5327 141sNW CONTRACTOR L&I CRAKAC*814L5 Plan Reviews Date Review Type Description Assigned To Review Status 12/09/2019 Demolition Building In Review 12/09/2019 Demolition PW Admin Rev In Review 12/09/2019 Demolitio- PW-Sew-Rev In Review 12/09/2019 Demolition PW-Wat-Rev In Review Fees Fee Description h;,tes Amouui Demolition Fee 322.10.00.00 $100.00 ProcessingrNchnology Fee 341.43.00.02 $25.00 State Building Code Surcharge Fee 386.00.01.00 $6.50 Total $131.50 UplWadedUMes Date File Name 12/09/2019 5968330-2927 Agnlication and Asbestos Testing,pdf DEMOLITION PERMIT APPLICATION Department of Community& Economic Development City of Arlington •.18204 59th Ave NE • Arlington,WA 98223 • Phone (360) 403-3551 THIS APPLICATION MUST BE ACCOMPANIED WITH A COPY OF THE ASBESTOS/DEMOLITION NOTIFICATION FROM PUGET SOUND CLEAN AIR AGENCY, TWO(2)COPIES OF AN ASBESTOS SURVEY REPORT AND ABATEMENT REPORT (if applicable)COMPLETED BY AN APPROVED AGENCY. Type of Permit:(check one) 15Q Residential ❑ Commercial ❑ Industrial /�,� Pro i.ect Address. 314 N 1—�AJC 11 /4- C Parcel ID#: ()0 �?�( � W ` oc)60 d Lot#: h Subdivision: Md `w04 11or��aluation GGd Building Area(Sq Ft) 10 C) No of floors Z Number of Buildings Owner: Cg ftj Ir'- C62` I I H Phone Numberod Address: zr7 q,' r� �2 1J6 City: C_(nl State: [dZ,4: Zip Code. Contact Person: /' C.If t3C,- Phone Number: CC-C-S - Cell Phone: �(J �3 L j(� E-mail: C o M KI� IAJ! c w C2'/—n�W •C." Address —J/ft4C 4-5, A5Lg!tJ City: State: Zip Code: Contractor: r-Hrtrr—lb�QV otOM Phone Number: J160 6 I 2 S-y0 Address: 9 -S �'' City: C-bQ n State: iW Zip Code: Contractor's License Number: Expiration: Z� Scope of Work: CoM UX0���1 d-j o f 90v:)C f- I hereby certify that the above information is correct and that the construction on, and the occupancy and the us Crakar Confi, ICtlrlg described property in accordance with the laws, rules and regulations of the Stat of Washington C� earth work App icants Signature D to Print Applicants Name CRAKAC*8141-5 PeC'P_.IV FOR STAFF USE ONLY 0EC 0 9 2019 ermit# A e'omcr ily Amount Received Receipt# Date Received � . �• ..�•� ,, _ - �� . ; • �_ �� �a ; � _ , � .. , '� �� • � i '� :. .� 7_ v,, ,��. � � .��A . ` E � � OMWBE Certifications No active certifications exist for this business. Apprentice Training Agent Not allowed to have apprentices. Workers' Comp No active workers'comp accounts during the previous 6 year period. Public Works Requirements Verify the contractor is eligible to perform work on public works projects. Required Training—Effective July 1,2019 Needs to complete training. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace Safety& Health Check for any past safety and health violations found on jobsites this business was responsible for. No inspections during the previous 6 year period. wasMngw.vw Labor&Industries(httns://Inima.gov). Contractors CRAKAR CONTRACTING Owner or tradesperson CHASE,CRAIG 14205 SE 36TH ST .................................................................. LANCASTER STE 100-288 Principals BELLEVUE,WA 98006-1596 CHASE,CRAIG 360-631-2500 LANCASTER,PARTNER/MEMBER KING County CHASE,KARRI R MOTOMATSU,PARTNER/MEMBER WA UBI No. Business type 604 440 491 Limited Liability Company Parent company CRAKAR LLC License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active Meets current requirements. License specialties GENERAL License no. CRAKAC"814L5 Effective—expiration 06/25/2019—06/25/2021 Bond Wesco Insurance Co $12,000.00 Bond account no 46WB103121 Received by L&I Effective date 06/25/2019 06/26/2019 Expiration date Until Canceled Insurance Ohio Security Ins Co $1,000,000.00 Policy no. BLS59810078 Received by L&I Effective date 06/25/2019 05/30/2019 Expiration date 05/30/2020 Savings No savings accounts during the previous 6 year period. Lawsuits againatthe bond or savings ... ....... ...... No lawsuits against the bond or savings accounts during the previous 6 year period. L8d Tax debts No L81 tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations ........................................... No license violations during the previous 6 year period. Certifications & Endorsements pscIeanair.org Puget Sound,'Jo.w A,r Agency Single-Family Notification Case#: 201906136 This page must be printed.A printout of the notification,all amendments to the notification,and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site(Reg III,4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction#AA3A3C3A2851 Transaction Date 12/10/19 Owner's Name Gene&Gloria Chase Phone (425)231-4600 Project Street Address 314 N French City Arlington Zip 98223 Contact Person Craig Chase Phone (360)631-2500 Mailing Address 21705 88th Drive NE Arlington,WA 98223 This project includes asbestos removal. Project Size linear feet / 80 square feet Project Start Date 12/10/19 Completion Date 12/10/19 Asbestos will be removed by the home owner This project includes a demolition. Demolition Start Date 12/20/19 Completion Date 12/27/19 Demolition will be completed by the home owner I certify that: (1)This is a single-family residence project.The structure is used by one family who owns the property as their domicile. (2)The information I have provided is to the best of my knowledge accurate and complete. (3)1 understand the fee for this Notification is nonrefundable. Create Another Notification If you have questions,contact us at asbestos 9pscleanair.org or 206.689.4058, Received DEG 10 2019 - --r - I� �I� r I C1; U SEATTLE ASBESTOS TEST, LLC Analyzing Qualit+7 Lyr:nwood tab:19701 5r•iber Lake Road,Suite 103,Lynnwood,%A A 9,W36,TeN25.r373.�G6U,Fax:425,673,3810,NVt AP Accredtation Leh Code:237768 Bellevue Lab:12727 Nonnup'daay.Suite 1,Bellevue,4VA 98Gfl5.Te,1:425.861_,1 11.Fax:425.551.1118,IJVLAP Accreditation Lab Code:200976 :Teethe Lab:4500 g?tz Ave.NE.Suite 300,Se?Pfle;WA 98105,teL'21'IF.633.111'i.k'�ax:206.633.474r,NVLAP Acrred@ation Lab Cade:201057 EmailatlrlinLdaeahl�askestostest.cam.'V�bsite:N4wsraP?EeastesPtsiesP.0 1Y �--y CHAIN OF CUSTODY Binh As6esbas F,nlnl Couw 400 1 I pm l co; t 1GoG ❑F a (Cootlt Grmvinie_;rlt 'ler t�,t�rciiyJ 5 Haut L G",if'i rSnm'r dos(G iL^ r I"�.1 �1 Da lll�J 111 �I Y � ''._)iIYS nvironMentaal Abatement Services, Inc. Tel: 360.7515.1O85 Fax: 360.588.4180 9 of Samples: Job#: Project Location:3 f Y QAch if� Project Manager: ,Mx Aec W[f1 --il:JeS-3y , i!Z Emeil:,4Sb�j '. 161M �44 OQ/¢CdL•C'GT SEQP CLIENT SAMPLE#' SAMPLEDES0,RIPtION LOCATION NOTES I 4P v JAY �r� A JS �.. I s RA tb 12 f. a: I 1 �� rb i GCi t.`rr• �d 14 Ifs '/7�-11P `�%,�° b � � � r,�a a lo► 18 19 20 Print Narne C lynature Company Date rime EnOronmental Abatement Semi 't- 9 r=flrgoi =ea: i ) FrlvirpnmentalAbaternent5ervi # l erna: FrIvironmental Abatement 9ervi Seavle Asbestos Test L �11) t I i� , , l�i - _•- -'�. lSeattle Asb=;stc�s Test zry ed: � 1 eattte Asbestas Test Seals1 r;sbntm re*:warfanaa the toal rriuAts to Ifn of a preotl norrntA rot the rypn And mvrtvraalnpy emotoycd to eadr sample wAx"Md and 6hdatott any otlwwarrants,ftwessed w imphod, im*,drg wmranty 0 61rest fry a Dolocblar pumo;c nd wonanty of machaelAdsdy.Seattle A%tdstos I dst a"et"no aogal rdoprN+trtaldy IN the pWPOW fo f yMWh thii rLMt uses the Lost,aavlls.By sfpung on tha farm.Ua clien4s tgfev to relieve GeAttle Asbestos Test of my nate4ly tlrra may onse Aom the test resulb.It is ate d wtt;tefpormtittty to tr*a tyre the samples are aottropnaley Wen accordwo to 1'"ImAl ann Irral ragrAnttona.Irnraccti paid Wfa may be char4M of atletesl,and,nv ti go to tnatcne/n m'ay be charged 17%to 2$`4 of eoftwAj r he,RSF checks-11 be chergad of SSa RnS.ults rcoon F-9 meth•3d: El Pupil. �Y2X LLLJJJ_ �L-- 11 Carrnnslke alf waFltzu:,n;samples Text result to ohn'l int r,. mk =:;or less asbestos Page 1 of i '= i I it I I Lynnwood Lzibor�tmy[19701 S,Ober Lake R,,ad,soHe iO3,LYrjt,,wjo(l,INA P80116,TeL 42,5-673-985(),Fax:425,67-IM10,NVLAP Lah Coda:200768-0 Ondatmer Inuti ruper,�mu,,ij not he Fe-deral go m6ed by ihe client Lo apploval,ot endmserlmnL bV scatile Astiestos,Test,Ul-NVLAP,NIST,cranny agency oru)e' ANALYTICAL LABORATORY REPORT PLM by Method EPA16001R,931116 M- J mrny W)cEw(',m Envinximental Abatement Services,Inc. Addma.: R 0,box 2 ;3,Mount Vegrion,VIA 98273 Jo"; N/A Oafthi: 201911542 Dat@Rpe&ived: 7)26,Q019 sampt08 R 0'd: 18 7,2612019 18 3114 NOM French Ave,Arlington, r WA 98223 Atk,*ad — keviewedby: Stove(Fmyao)Zhw%g.Pmsitart L'a b€Q AiNIVestos I TM-I White brittle one Ftile Binder, Paitft 2 CeiluloSe material with paint detected Black asphaltic None Asphait1binder, 28 Glas5 fibers 2 TM-2 material with said detected Sand 2 Black asphaltic None Asphalt/binder 3 Cellulose material detected I Dark gray sheet None Vinyl/binder Name detected vinvI detected 2 Yellow/clear mastic None Mastfc*inder 2 Cellulose detected 3 Gray soft m ateria; None detected Filler, Binder 3 Cellulose 4 White sheet vinyl None Vinyltbinder None, detected detected Cray fibrous None Biriderifiller, material wib) detected Masticibinder 65 Ceifulose 3 TM-3 n1astic While t4(1 None Vinyllbinder, 2 Cellulose detected Mineral grains 7 Clear mastic None Mastic/binder 4 Cellulose detected I 8 Beige sheet vinyl None Vinyl/binder None detected detected Gray ribrous Binderffiller, material I'vith 50 chrysotile mastic Masticlbinder 37 Cellulose I 10 Brown wood block None ted Wood aggregates 5 Cellulose detec 1 Light gray sheet None Vinyl/binder None detected Vinyl detected 2 Yellow/clear mastic None Iviastic/binder 2 Cellulose detected 3 Gray soft tyiaterial None detected Filler, Binder 3 Cellulose 4 4 Beige sheet vinyl Nonected vinyl/binder None detected TM-4 dete 5 Gray fi brous None Binder/filler, material with masticdetected Mastic/binder 68 Celll-lfoSe 6 Red vinyl None detected Vinyl/binder 2 Cellulose 7 Black asphalljc None Asphalt1binder, fibrous material 70 Cellulose WIV)mastic detected Mastic/binder, Filler 57l 1 White sheet vinyl None -T\/iny/binder None detected detected 1 Of 3 _ � �' I V Lyanaersad;sbnretory:19709 ecnhw Lake Raad<S�,ile':O3,Lynmvood,VVA 980,36,Tni:42.6 673.9850,F.ax:425.673.981f,`,N\„ P Lvb Cade:2E0076a-0 Disdaimer-ThlS ropoit must not See�;sed by the client to claim prerJuct certificafion,approval,or endorsemer,i Federal Uovernmont bq Sea tie Asbes?©s Tes;,L LG,NV LAP,P11S?,a ac�any enry of tine ANALYTICAL LABORATORY REPORT PLM by Method EPAJGOOIR-931116 ann.: Jinwiy MacEwon silent. Environmental Abaternen4 SeVices.IJic, AJare.s; P.O.Box 2503:h9ecu1t Vemnn,VJA 98273 Jub,4: NdA e­hg: 201911542 Dw.Res vN& r= 7126i2E11„ S.mvlmRaed: 18 OaseAn*zedf V2612019 &ams�des,Cnalyzetl: 15 Pmjec€l.,no.: 114 North French Ave,Arlington, t WA 98223 /trazlyxe<�t hy. ui Y ng Rem."by: S%7v(Funygo)Ctrong,J OSII W Lab ID client Sample 10 l qvK UescApt0r3 is S.estos No us Components ): Ncn-asbestus Fibers Dray fibrous on Binde/filler, 5 TM-5 2 Material with Mastic/binder, 66 Cellulose mastic and debris detected Debris 6 TM-6 .I Brown fibrous None Filler, Paint 90 Cellulose material with paint detected 1 Brown paper with None Filler, Paint 75 Cellulose - — 7 TAR-7 2aint detected 2 Brown/gray fibrouS None material detected Filler 92 Cellulose 9 White paper with None aint detected Filler, Paint 77 Cellulose 2 Clear mastic Norte Mastic/binder 2 Cellulose detected 6 Tel-6 3 Brown paper with None aint detected Biller, faint 70 Cellulose 4 Clear Mastic None Mastic/binder 2 Cellulcsf�- €detected 5 Brawn fibrous None Filler, faint 96 Cellulose material with paint detected 9 Brown paper with None Filler, Paint 73 Cellulose paint detected 9 TM-9 2 Clear mastic None Masticibinder 2 Cellulose detected 3 Brown fibrous None Filler, Paint ffitf Cellulose Material with paint detected None 1 Cray)�YJrc�us detected Paint, tiller, Perlite 91 Cellulose material wish ainf dete 10 TM-10 2 Beige mastic Nye defeated Mastic./binder 2 Cellulose 3 gown peer with None Filler, Paint 79 Cellulose paint detected t Brown paper with None paint detected Filler, Faint 70 Cellulose i 9 TM_11 2 Clear mastic; None detected 11�asticlbinder 2 Cellulose - - Brawn Tbrous lone _ material with paint detected Filler, Paint 94 Cellulose 1 Brown paper with Nome aint detected Filler, Faint 73 Cellulose 12 TM-12 2 Clear Mastic None Mastic/binder 2 Cellulose detected 3 Brown fibrous None Filler, Paint 96 Cellulose material with paint detected 1 White powdery None Binder/filler, Paint 5 Cellulose 13 TM-13 Material wia)paint detected 2 Brown fibrous one material with aint detected Filler, Faint 90 Cellulose 2 of 3 �- ti II �: �1 I Lynnvvc*d Labo(wory.19701 scrtber Lake Road,Suite 103,i-ytvrwoDd,WA 98036,T-oC 425.673.3350,Fix:426.671-0810,NVLAP 1-ib Code:200768-0 Disdaimer:This report mustnot be used by then client to cjaimj product approval, by Seattle AMiesiDs Test,1-1-C,NVLAP,NIST, ),any agency ofthe Federal yownnMnt. ANALYTICAL LABORATORY REPORT PLM by Method EPA1600IR-931116 Afbtz ,lima w MacEevoo Emnronmenlal Abotement ser.�Icas'111C Add,o..v.-. R O.Box 2503,Mourtt Vernaij,%vA 98273 Job#.- WA BOO#: 201 91 1 542 Dat.mReztived; V2&2019 Sgmplc.Reed; 18 Date Aaly—& 7/,!Z6/20j 9 omaly"d: 18 Fr*cU6t.: 314 North rmncli Ave,Arlingtoit VJA 98223 M�abgwl'by,, YLn RevIbw.'J by: blava(FPyA*i 7ha19.Preskfwd 'y y Lab ID C1111r,-1.10.ID 1-ayer Description F1 o No .0 sws Car�jpc� in-asbestos Fibers; neots Green/beige Sheet**�Gne Q, 1 vinyl Viny inder None detected 14 TM-14 — detected 1 2 Black mastic with None Masticibinder, 5 1 Cellulose debris detected Debris 1 Light gray sheet None Vinyl/binder None detected — Vinyl detected 2 Yellow/clear mastic None Mastic/binder detected 2 Cellulose 15 TM-1 5 3 G 1 Green sheet)A None Vinyl/binder None detected —- — I detected 4 Black clear mastic None Mastic/binder 2 Cellulose -- detected Black asphaltic 5 fibrous material None AsphalUbinder, 76 Cellulose With mastic detected Mastic/binder, Filler White powdery None 16 TM-16 - I material vA tithpaint_ detected Binderifiller, Paint 3 Cellulose Brown fibrous None 2 material detected Filler 90 Cellulose I Beige sheet vinyl None Vinyl/binder None detected Gray fibrous detected 2 imate6al with None BinderUer, 61 Cellulose detected klastic./binder 17 TM-1 7 rgastie 3 Tan vinyl Notre Vinyl/binder 2 Cellulose --- detected Black asphaltic None Asphalt/bin.der' fibrous material detected Mastic/binder, 4 Filler 70 Cellulose with mastic I Tan vinyl detected Vinyl/binder 2 Cellulose TM-'1 8 2 Black asphaltic None Asphalt/binerd fibrous material 6' Cellulose Mastic detected Mastic/binder,Filter 3 of 3 1 )Regional Disposal Container# WASTE SHIPMENT RECORD 1. Waste Generated Site Name and Address: Owner's Name: Owner's Phone No.- 2, Operator's Name and Address: Operator's Phone No. G 3, Waste Disposal Site(WDS)Name,Address,and Physical Site Location: WDS Phone No.: E Regional Disposal Co. 1-800-275-5641 500 Roosevelt Grade Rd. N Roosevelt,WA 99356 4, Responsible Local,State or EPA Agency Name and Address: P.S.Clean Air 1904 Third Ave. E Suite 105 Seattle,WA 98101 R 5. Description of Waste Materials. 6, Containers 7, Total Quantity No Type m3 Cyd3) A Asbestos Containing Materials T 8, Special handling Instructions and Additional Information: O DOUBLE BAGGED & LABELED R 9. OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by highway according to applicable international and government regulations. Printed/Typed Name Signature Month Day Year T 10. Transporter 1 Acknowledgment of Receipt of Materials R Printed/Typed Name Sighature Month Day Year A N S P 11. Transporter 2 Acknowledgment of Receipt of Materials- 0 nature Month Day Year R Printed/Typed Name Sig ,. Rabanco Transfer '!! T E 2733 3rd Ave,S. R Seattle,WA 98101 206-652-8865 12. Discrepancy Indication Space VY A Waste Disposal RRLC S T E 13. Authorized Waste Disposal Site Owner or Operator: Certificafion of receipt of asbestos materials covered by this manifest S except as noted in item 12 Printed/Typed Name Signature Month Day Year T E Received WHITE: Return to Operator YELLOW: Waste Site PINK: Transporter WHITE: Operator DEC 09 2010 ?�'a m'0 .� I .� '�, ;� TE AW Regional Disposal - 3rd & Lander 206-336-1365 S�E01 TICKET# 1121388 CELL 2733 3RD AVE SOUTH SEATTLE, WA 98' WEIGHMASTER I - Florence D. OUT - Kim L. JSTOMER 010030 DATEMME IN DATE/TIME OUT CASH CUSTOMER 12/6/19 10:54 am 12/6/19 11:00 ar 1 fr VEHICLE CONTAINER Seatr,.Te, WA 1111 CASH RESI REFERENCE Contract:ASBSETOS FRIABLE UNDER 750 LBS CRAIG CHASE BILL OF LADING RBAU200016 SCALE IN GROSS WEIGHT 9,720 NET TONS 0.04 INBOUND SCALE OUT TARE WEIGHT 9,640 NET WEIGHT 80 CASH OTY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL 0.00 YD Tracking QTY 0.04 to SW-ASBESTOS-FRIABLE Origin:SNOHOMISH-OT/SNOH 100% $256.00 $97.00 $3.49 $100.49 Tax Total Washin ton State R. $3.49 Payment(a) CREDIT CARD-SCALE $100.49 $100.49 TENDERED $100.49 The undersigned individual signing this document on behalf of Customer acknowledges that he or she has read and understands the terms and conditions CHANGE on the reverse side and that he or she has the authority to sign this document on behalf of the customer. $0.00 CHECK# 2S-F042UPR(07/12) SIGNATURE �ivC) ��� LyronvioOd Laboratory: Sty1ber Lake Roaa,Suk,'103,Lyffinwoad,WA 48036, 426.673,9860,Fax:425,673,98W,NVLAP Lab Cadez 20076&0 Project Manager: JtMMY MaCENnn Date Analyzed: V261201 9 Client: Environmental Abatement Services,tnc, Client Job* NIA Address: P.C.Box 2503,MOUrtt Vemon,WA 98273 Project Location: 314 North French Ave Arlington, WA 98223 Tel: 360355.1085 Laboratory batch,#, 20191 1 M2 Samples Rameivedc 18 Enclosed please find the test results for the bulk samples submitted to our laboratory for asbestos analysis.Analysis was performed using polarized light microscopy(PLM)°n accordance with Test Method US EP,4j6Oo/R-93/1 1�. Percentages for this report are done by visual estimate and relate to the suggested acceptable error ranges by the method.Since variation In data increases as the quantity of asbestos decreases toward the limit of detection,the EPA recommends point counting for samples containing between<1%and 10%asbestos(NESHAP,40 CFR Pan 61). Statistically,point counting is a more accurate method.If YOU feel a point count might be beneficial,please feel free to call and request one. The test results refer only to the samples or items submitted and tested.The accuracy with which these samples represent the actual materials is totally dependent on the acuity of the person who took the samples.This report must not be used by the client to claim product cerlificabori,approval,or endorsement by Seattle Asbestos Test,LLC,NVLAP, NIST,or any agency of the Federal government.The test report or calibration certificate shall not be reproduced except in full,without written approval of the laboratory, This report is highly confidential and will not be released without your consent, Samples are archived for 30 days after the analysis,and disposed of as hazardous waste thereafter, f hank you for using our service and let us know if we can farther assist you. Sincerely Steve(Fanyao)Zhang President i Raelynn Jones From: Raelynn Jones Sent: Tuesday, December 10, 2019 10:30 AM To: Craig C Subject: Demo question Hi Craig, Did you obtain an Asbestos/Demolition Notification from Puget Sound Clean Air Agency? If so, can you please provide a copy? (electronic would be just fine) htt s: pscleanair.gov/188/Contractor-Demolition Sincerely, Raelynn Jones Permit Technician City of Arlington Community& Economic Development 18204 591h Ave NE Arlington, WA 98223 Office: 360-403-3436 www.arlingtonwa.gov 1 I� i ■ � r; i 1 pscIeanair.org Puget Sound C lo,m Aa Agency Single-Family Notification Case #: 201906146 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # AL3A66C90551 Transaction Date 12/11/19 Owner's Name Gene &Gloria Chase Phone (360) 631-2500 Project Street Address 314 N French City Arlington Zip 98223 Contact Person Craig Chase Phone (360) 631-2500 Mailing Address 5327 141st Place NW Stanwood, WA 98292 This project includes a demolition. Demolition Start Date 12/13/19 Completion Date 12/19/19 Demolition will be completed by the home owner This is an emergency project. The emergency reason: The project must proceed to avoid imposing an unreasonable burden. I certify that: (1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile. (2)The information I have provided is to the best of my knowledge accurate and complete. (3) I understand the fee for this Notification is nonrefundable. Create Another Notification View History Log Out If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. I ., ti DEMOLITION PERMIT APPLICATION Department of Community&Economic Development City of Arlington -.18204 59th Ave NE -Arlington,WA 98223 - Phone(360)403-3551 THIS APPLICATION MUST BE ACCOMPANIED WITH A COPY OF THE ASBESTOS/DEMOLITION NOTIFICATION FROM PUGET SOUND CLEAN AIR AGENCY, TWO(2)COPIES OF AN ASBESTOS SURVEY REPORT AND ABATEMENT REPORT (if applicable)COMPLETED BY AN APPROVED AGENCY. Type of Permit:(check one) Residential ❑ Commercial ❑ Industrial Project Address 3lf-F f��C�I/�(��)4y'e�� /ParcellD#: OD3-ZCf` w `fyo600 Lot#: t Subdivision:=- 4M4,yd �-Valuation: GC,G Building Area(Sq Ft) No. of floors: 7— Number of Buildings l Owner: , I C Phone Number: 5� l��Qa Address Z/ ��r� �Z NC City C-1"� State: —L4 Z& Zip Code: Contact Person: /'�/'t'f C �f 03C-_ Phone Number: Cell Phone: S G(1 0 E-mail: co(J &t� 7/U!5 D C -C" Address: J'1'4C I City: State: Zip Code Contractor: 11 Phone Number: 360 Address: s � � City: State Zip Code: Contractor's License Number: Expiration Z� Scope of Work: I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above- described property in accordance with the laws, rules and regulations of the Stat of Washington App scants Signature D to / (r(c Si r Print Applicants Name Received FOR STAFF USE ONLY DEC ® n 2019 Permit# Accepted By Amount Received Receipt# Date Received e7 Regional Disposal Container WASTE SHIPMENT RECORD � 1/ ,-. (,_ 1, Waste Generated Site Name and Address: Owner's Name: Owner's Phone No 2, Operator's Name and Address: Operator`s Phone No. G i 3. Waste Disposal Site(WDS)Name,Address,and Physical Site Location: WDS Phone No.: E Regional Disposal Co. 1-800-275-5641 500 Roosevelt Grade Rd. N Roosevelt,WA 99356 d, Responsible Local,State or EPA Agency Name and Address: PS.Clean Air 1904 Third Ave. E Suite 105 Seattle,WA 98101 R 5, Description of Waste Materials: 6, Containers 7, Total Quantity No Type m3 (yd3) A r ' Asbestos Containing Materials T B. Special Handling Instructions and Additional Information: O DOUBLE BAGGED & LABELED R 9. OPERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by highway according to applicable international and government regulations. Printed/Typed Name Signature Month bay Year T 10. Transporter 1 Acknowledgment of Receipt of Materials R Printed/Typed Name Signature Month Day Year A N S P 11. Transporter 2 Acknowledgment of Receipt of Materials- 0 Printed/T R yped Name Signature Month Day Year T Rabanco Transfer E 2733 3rd Ave.S. R Seattle,WA 98101 206 652 8865 i 12. Discrepancy Indication Space W Waste Disposal RRLC A S T E 13 Authorized Waste Disposal Site Owner or Operator: Certification of receipt of asbestos materials covered by this manifest 5 except as noted in item 12 Printed/Typed Name Signature Month Day Year T E ® Received WHITE: Return to Operator YELLOW: Waste Site PINK: Transporter WHITE: Opper ottor DEC 09 2019 TE AW Regional Disposal - 3rd & Lander 206-336-1365 SITE01 TICKET# 1121388 CELL 2733 3RD AVE SOUTH SEATTLE, WA 98124 WEIGHMASTER IN - Florence D. OUT - Kim L. 1STOMER 010030 DATE/TIME IN DATE(TIME OUT CASH CUSTOMER 12/6/19 10:54 am 12/6/19 11:00 ar 1 VEHICLE CASH RESI CONTAINER Seat , WA 1111 REFERENCE CRAIG CHASE Contract:ASBSETOS FRIABLE UNDER 750 LBS BILL OF LADING RBAU200016 SCALE IN GROSS WEIGHT 9,720 NET TONS 0.04 INBOUND SCALE OUT TARE WEIGHT 9,640 NET WEIGHT 80 CASH OTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL 0.00 YD Tracking QTY 0.04 to SW-ASBESTOS-FRIABLE Origin:SNOHOMISH-OT/SNOH 100% $256.00 $97.00 $3.49 $100.49 Tax Tota Washin ton State R. $3.49 Payment(s) 41 CREDIT CARD-SCALE $100.49 $100.49 TENDERED $100.49 The undersigned individual signing this document on behalf of Customer acknowledges that he or she has read and understands the terms and conditions CHANGE on the reverse side and that he or she has the authority to sign this document on behalf of the customer. $0.0 0 CHECK# 2S-F042UPR(07/12) SIGNATURE -Al Lynnwood Labe story:19701 Scriber Lake Road,SuRe 103,LYrMWOOd,WA 99036,1rel:426.6119850,Fax:425,r'73,9810,NVLAP Lab Code: 200768-0 W)'"V tIlfia€tirla";Iae�toste"qt.r.onl. Project Manager: Jimmy MacEvvon Date Analyzed: 7,2612019 Client. Environmental Abatement Serviceq,Inc, Client Job#: N IA. Address: P.0,Box 2503,Mount demon,WA 98273 Prrjjsct Locatjorl, 314 North French Ave,Arlington, WA 96223 TO °360.785,1085 Laboratory batch: 201911542 Samples Receiva& 18 Enclosed please find the test results for the bulk samples submitted to our laboratory for asbestos analysis.Analysis was performed using polarized light microscopy(PLM)in accordance with Test Method US EPA/600/R-931116. Percentages for this report are done by visual estimate and relate to the suggested acceptable error ranges by the method.Since variation In data Increases as the quantity of asbestos decreases toward the limit of detection,the EPA recommends point counting for samples containing between<1%and 10%asbestos(NESHAP,40 CFR Part 61). Statistically,point counting is a more accurate method.If you feel a point count might be beneficial,please feel free to call and request one. The test results refer only to the samples or items submitted and tested.The accuracy with which these samples represent the actual materials is totally dependent on the acuity of the person who took the samples.This report must not be used by the client to claim product wrlification,approval,or endorsement by Seattle Asbestos Test,LLG,NVLAP, NISI,or any agency of the Federal government.The lest report or calibration certificate shall not be reproduced except in full,without written approval of the laboratory. This report is highly confidentiat and will not be released without wur consent.Samples are archived for 30 days after the analysis,and disposed of as hazardous waste thereafter, Thank you for using our service and let us,know if we can further assist you, Sincerely Steve(Fanyao)Zhang President S ATTLE ASBESTOS TEST, LLC Analyzing Quality Lynnwood Lab:18761 7ruiber Lake Road,Suite 103,Lynnwood,WA 893-6,Te€:425_673_9350,Fax:425.673.9810,NVLAP Accreditation Lab Code:2:3f3768 8rtllevue Lab:12727 Nort lup J1ay,Suoe 1,Selievue,WA 98005,Tel:425,861.1111,Fax425361.1118,NVLAP Accrediation Lab Code,20Ci876 Seatt€e Lab:4500 9th Ave_Nr..SuVi e 300,Seattle;VGA 93105,Te1.206.6:33.1111.Fax:206,63'z.4747,N VLAP Aer_mthlatioll Lab Code:201$067 Email:ad minC�seaftleaabesrostes?cmr a rNe65Ae:wtw�srauleas �loSt�sP.catn CHAIN OF CUSTODY Sulk As basics El F>:int(:aunt 400 El' Pohl Count 1000 ❑Phmn coop Gravime:ric a otnor(fipr_ciry) �+ i Hrn.�r 2 sirs err U 5ttme dEy(d is fx H,s.) Iffj pay ;aays Environmental Abatement Services,Inc. Tel: 36V55.1085 Fax: 360,588,4180 #01 Samples: .3ob#: Pmject Location: Project manager:j/T/IX ecr�--WC,4 001:1 Z5-JY6-9WZ Eme:A'b,�y SECT# CLIENT SAMPLE# SAMPLE DESCRIPTION LOCATION NOTES t ? v 6 ) r 4 r3/ 1 �'-� L✓ i C i� ( Labr'r� 1 1?tick sus .c c ' -TA ITC;d- RA i f( rb r G i l>S� ,Qgccl 13 14 1f Ar ` Z14�tr fi — 16 17 'ill­/7 '^ 1i7-I C F20 't 9 Print Name Slyna re Company Et, — s �plzd T nvirDnmenial Abatement Servi 1 f ; Fnvir�nmental Abatement Servi t I L °ls`�rrtl Environmental Abatement Serve tt t j - r /' , Seattle Asbestos Test SeattleAsbLstosTzst 1,r ' F;etwrted: d ¢ Seattle Asbestos Test S,duth Fet.•astos Tar.watranew rhm teat rn.uha to bn of a pteauen rvfrn�l la th a type aria mouvitloln0y.imptpycd for verb santitta xtlrtntlted orb diadwims any otharviarrants.eypret red o+vnpked itxhtr6nq warranty cf duk:..ftx a Oar?tulm putpose.nxf wturOnty of morchaatat.bty.SeaAe ntea.tox:e.:accavtu no toga)reoponalakty Im the purpose forvA+tch the dmnt t:ses Mo test reauh.Fry sigmn9 on Ihn fetm.Via didtrts ttfjtce to rel;eve Seattle Asbestos Test d any ifah5ly that may anse from tts lest reutlis,It is the d eM3 re*artsbkty to make sum the sMtples are appra"ately take accortknp to tultrrtl and Imal repulutione i w6m Aoki alto may 6a ehargi d of mlem%L and.rive%";po fo cMlacban.nay he sturpad V%to 26`a of coltaratoi fee.NSF miteks xdl be charged of$50. R^,rafts rarxrrrirr meth�,d: Ll Praha -marl 11 Ra-wp 11 `c�X �f7 G((I aacite alf wallb�rti samples 11 Text result to ph --'one W t co.M .;ate,,o,less asbestos 'jade i of(} Lynnwood Laboralury IP7Cj1-'�Criber Lake Road,Sure 103,Lyryr,,'wrjrA',NA 98036,TeL 42-5.6719P,50,Fax:44.673,9810,NVLAP Lan Coda:ZO()768-0 Disdamier:Tills rama must not he used by the shunt to aorjurl re,rIjfioaficn,approval.(,,s 611domoment by�3,�aklle A'hestb',Test, Federal govemment. UC,NVLAP.NIST,or any agency of the ANALYTICAL LABORATORY REPORT PLM by Method EPA16001R.93,1116 Jimmy MacEwun Environmental Abatampnt Add msw R Cp.Box 2503.Mount Vetrm n,)NA 98273 Sprvlms,Inc. JA4; N/A OWOP 201911542 Da[®Received: 7/2612019 sampk-s%ed� 18 OW,Arrafyud; 7,2612019 is-ptes AWyzed: 18 N�.Ct Loc-, 314 North French Ave,Arlington, WA 98223 As~ 'It Lab M cfielrt8anlple lf-) I-ayer A466tos N drays Componer,-,-, 1/b ribus TM-1 I White brittle 'o e *Fffl, , Bi'rnder, Paint 2 Cellulose material with paint detected I Black asphaltic None Asphalt/binder, 28 Gia5s fibers 2 TM-2 i material with sand detected ;and 2 Black asphaltic None Asphalt/binder 3 Cellulose material detected Dark gray sheet None 1 vinyl , detected Vinyl/binder None detected 2 Yellow/clear mastic None MasFaibinder 2 Cellulose detected 3 Gray soft material None Filler, Binder 3 Cellulose detected 4 White sheet vinyl None Vinyl/binder None detected detected Gray fibrous None Binder/Filler, material �!,Mh detected Mastic/binder 65 Cetlulose done Vinyl/binder, 6 kA)hito tilt, 2 Cellulose detected t Mineral grains 7 Clear mastic None Mastic/binder 4 Cellulose detected 8 Bei'w'sheet vinyl None Viiiylibinder Non Detected I e detected Gray fibrous Bindedfiller, 9 material with 50 Chrysotile 37 Cellulose mastic Mastic/binder I() None Brown wood block detected Wood aggregates 5 Cellulose Light gray sheet None 1 vinyl detected Virtyl/binder None detected 2 Yellow/clear mastic None Masticibinder 2 Cellulose detected 1 3 Gray soft material None detected Filler, Binder 3 Cellulose 4 Beige sheet vinyl None Vinyl/binder None detected 4 TM-4 Gray fibrous detected 5 material with None Sinder/filler, 68 Cellulose mastic detected Masticj'binder 6 Red vinyl None I detected Vinyl/binder 2 Cellulose 7 Black asphaltic. None AsphalUbinder, fibrous material detected MasticlbHder, Filler 70 Cellulose with inastic I 1 1 5 M-5 1 White sheet vinyl None Vinyt/binder None detected detectedJ I of 3 Lynnutnaai i aboratoy:99709 Sodbor Lake kixart,Suite 21J3,Gyrvnveoo,l,VVA W636.TeL 425,6739850,I ax:425,673.tJS'.G NVLAP Lab Code:20076M, Oiscialmei:This report must not be used bV the client to claim predur t certifiuWon,approval.or ndoraemer by Seatfle Federal government. Asbel os Teri,LLG,NW1.AP;MIST,or any agency,of the ANALYTICAL LABORATORY REPORT PLM by Method EPAXODIR-93{i16 Anm, Jimmy MacEwen chant: Environmental Abatement Services,Inc. Adam...: P,O.(3ox 26U3,Pel,)U"t Vernon,wrA 98273 3ntts: N/A Batch& 2019 11542 Date Received: 7i2612p 1 q 5airrples Nae'tf: 1$ pate Analyzed: 712612019 Sampl-Analyzed: 18 Pmiect Lnc.: 314 North French Ave,Adingtot), r WA 98223 A,n3lyz�d by. nevie�aed by: 54ey°e;Fen�0ts7 Th,ag,PPay.;idT„st Lfio il"i Client sample I Layer sbestos a Nlu{di ie Components 5R NcraaAbesios Fibers Gray fibrous � Binde/filler, a TM-5 2 material with Kane Masticlbinder, 66 Cellulose mastic and debris detected Debris 6 TM-6 1 Brown fibrous None Filler, Paint 90 Cellulose r�tater€al vvith paint detected 1 Brown paper with None Filler, Paint 75 Cellulose 7 TM-7 Paint detected 2 Brownitgray fibrous None material detected Filler 97 Cellulose 1 White paper with None Filler, Paint 77 Cellulose aint detected 2 Clear mastic Norte Masticlbinder 2 Cellulose detected 3 TM-8 3 Brown paper with None Filler,Paint 70 Cellulose Paint detected 4 Clear mastic None Mastic/binder 2 Cellulose detected 5 Brawn fibrous None Filler, faint 96 Cellulose. material With paint detected 1 Brawn paper with Norte Filler, Paint 73 Cellulose Paint detected 9 TM-9 2 Clear mastic None Masticlbinder 2 Cellulose detected 3 Brown fibrous None Filler, Paint 90 Cellulose material with paint detected 1 gray fibrous None Paint, Filler Perlite 91 Cellulose material with Paint detected 10 TM-10 2 Beige mastic None detectedMastic/binderCellulose 3 Brown gaper with None taint detected Filler,Faint 79 Cellulose 1 Brown pap Wiwith None Filler, Paint 70 1 Ceilulose _Paint detected 11 TM-11 2 Clear mastic Nome Mastic/binder 2 Cellulose detected 3 Brown fibrous None Filler, Paint 94 Cellulose material with paint detected 1 Brawn paper with None Filler, Paint 73 Cellulose taint detected! 12 TM-12 2 Clear rr<astic None Masticlbinder 2 Cellulose detected Brown fibrous None Filler, Paint 96 Cellulose material with paint detected 1 White,powdery None 13 material with paint detected Binr9erlfiler, PaintCellulose TM-'l 3 2 Brown fibrous None Filler, Paint 90 Cellulose 1aterial with aint detected 2 of 3 Lyn rwc*61-abarstory:1,1701 Scriber UAe Poid,Suite 1()3, 'XAQBW6,TOL 426.673.9850,Fax:42,5_C,3.98W,NV AP Lab Gede:200768-0 DW9(Wr.'TNSreport mijsP not be ijsed by the clientio ciai,n product ceorfic.011w.approval,Or bySeaWeAsbo%tos Test,1-1-C,WtAP,NISI,0.,arty agency of tjl(,, FoUral Wymnmbm, ANALYTICAL LABORATORY REPORT PLM by Method EPA1600IR-OV116 Jimniv MacEwon ckm�� Environmental Ahaternent Addp.%: P,U.Box 2503,MOUnt Vernon.WA 98273 Services.Inc. Job#: N/A Be h#: 2019115,42 OateR,ec&fd; 7)26)2019 Sompl—p—,d: 18 0,Ae A—Iy-d 7/2612019 S—ylr.AnWyud: Prol�c&Loc.: 314 North French Ave,Aflingtan WA 98223 rmt:lred(A Revtewe,,bye 8lcv4(Fanym)ZN".Pre" Lab D Clifl-ritSarnple 10 Laver De-srrintion % Awbut..F co..po,,,�Ols Fibers Green/beige sheet N ne Viny4nder None detected it 14 TM-14 vinyl detected 2 Black mastic with NoneMastic/binder, debris detected Debris 5 Cellulose 1 Light gray sheet None Vinyl/binder — None detected vinyl detected 2 Yellow/clear mastic None Mastickinder 2 Cellulose detected 15 TM-1 3 Green sheet vinyl None Vinyl/binder None detected 5 detected 4 BlaGkIclear mastic None Masticlbinder 2 Cellulose detected halUbinder, None Asp , 5 fibrous material 76 Cellulose with mastic detected Mastic/binder,Filter I White powdery None Binder/filler, Paint 3 Cellulose 16 TM-16 rnaterial with paint detected 1 2 Brown fibrous None Filler 90 Cellulose material detected I I Beige Sheet vinyl None Vinyllbinder None detected —,— detected Gray fibrous None 2 material with Binderffiller, 61 Cellulose 17 7M-1 7 mastic— detected Mastic.1binder 3 Tan vinyl None Vinyltbinder 2 Cellulose detected Black asphaltic 4 fibrous material None Asphallfbinder, with mastic detected Mastic/binder..Filler Cellulose J�—on—e I Tan vinyl detected VinyUbilider 2 Cellulose 18 TM-18 Black asphaltic 2 fibrous material None Asphaltibinder, 69 Cellulose 1 with mastic detected Mastic/binder,Filler 3 of 3 CITY OF ARLINGTON e / 238 N. OLYMPIC AVE - ARLINGTON, WA. 98223 PHONE; (360) 403-3551 BUILDING PERMIT Address:314 N French Ave Permit#:2927 Parcel#:00529900400600 Valuation:4000.00 OWNER APPLICANT CONTRACTOR Name:GCGC INVESTMENTS LLC Name:[Company Name] Name:Crakar Contracting Address:21705 88TH DR NE Address:[Company Address] Address:5327 141st PL NW City,State Zip:ARLINGTON,WA 98223-8940 City,State Zip:Stanwood,WA 98292 City,State Zip:Stanwood,WA 98292 Phone: Phone:360-631-2500 Phone:360-631-2500 LIC:CRAKAC*814L5 EXP:06/25/2021 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Demolition CODE YEAR: 2015 STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION 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 WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC1I0/IRC110. SALES E:Sales x relating to construction ai ruction materials in the City of Arlington must be reported on your sales tax return form and cod f Arli tt . 101. / r ignature Print Name Da c Relealea Bybate' CONDITIONS Existing Side Sewer will need to be capped at the property line or where the 4" X 6" transition fitting is found. Contact the Wastewater Department at 360-403-3508 for inspections 24 hours in advance. Contact Water Department at 360-403-3542 prior to demo for water meter removal. Approved job copy shall be onsite for inspections; if applicable. Call for final inspection. 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 FEES Date Description Fee Amount 12/11/2019 Demolition Fee $100.00 12/11/2019 Processing/Technology Fee $25.00 12/11/2019 State Building Code Surcharge Fee $6.50 Total Due: $131.50 Total Payment: $0.00 Balance Due: $131.50 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon psc lean air.org Puget Sound Clean Air Agency Single-Family Notification Case #: 201906136 This page must be printed.A printout of the notification,all amendments to the notification,and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site(Reg III,4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction#AA3A3C3A2851 Transaction Date 12/10/19 Owner's Name Gene&Gloria Chase Phone (425)231-4600 Project Street Address 314 N French City Arlington Zip 98223 Contact Person Craig Chase Phone (360)631-2500 Mailing Address 21705 88th Drive NE Arlington,WA 98223 This project includes asbestos removal. Project Size linear feet / 80 square feet Project Start Date 12/10/19 Completion Date 12/10/19 Asbestos will be removed by the home owner This project includes a demolition. Demolition Start Date 12/20/19 Completion Date 12/27/19 Demolition will be completed by the home owner I certify that: (1)This is a single-family residence project.The structure is used by one family who owns the property as their domicile. (2)The information I have provided is to the best of my knowledge accurate and complete. (3) 1 understand the fee for this Notification is nonrefundable. Create Another Notification If you have questions,contact us at asbestos@pscleanair.org or 206.689.4058. Date: 03/31/2026 Permit#: 2927 Permit Date: 12/09/2019 Review Date: 12/09/2019 Permit Type: DEMOLITION Review Type: DEMOLITION Target Date: 12/16/2019 Scheduled 00:00 Time: Completed 12/11/2019 Date: Description: Existing Side Sewer will need to be capped at the property line or where the 4" X 6" transition fitting is found. 2. Contact the Wastewater Department at 360-403-3508 for inspections 24 hours in advance Review Status: Assigned To: PW-SEW-REV Time In: 00:00 Time Out: 00:00 Hours: 0.0 Property Information Parcel#: 00529900400600 GCGC INVESTMENTS LLC GCGC INVESTMENTS LLC 21705 88TH DR NE 314 N FRENCH AVE ARLINGTON, WA 98223-8940 Zoning: I I I Single Family Residence - DetachedLot: Block: Permit#: 2927 Permit Date: 12/09/19 Permit Type: DEMOLITION Project Name: Chase Demo Applicant Name: Crakar Contracting Applicant Address: 5327 141 st PL NW Applicant, City, State, Zip: Stanwood, WA 98292 Contact: Craig Chase Phone: 360-631-2500 Email: crakarcontracting@gmail.com Scope of Work: Demo of existing SFR Valuation: 4000.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: ID Code: Permit Issued: 12/12/2019 Permit Expires: Form Permit Type: Status: COMPLETE Assigned To: Raelynn Jones Property Parcel# Address Legal Description Owner Name Owner Phone Zoning GCGC 00529900400600 314 N FRENCH AVE INVESTMENTS Residence Single Family -Detached LLC Contractors Contractor Primary Contact Phone Address Contractor Type License License# Crakar Contracting Craig Chase 360-631-2500 5327 141st PL CONSTRUCTIONNW CONTRACTOR L&I CRAKAC*814L5 Plan Reviews Date Review Type Description Assigned To Review Status 12/09/2019 DEMOLITION BUILDING 12/09/2019 DEMOLITION No comments for this demo permit,LT PW-ADMIN-GIS Existing Side Sewer will need to be capped at the property 12/09/2019 DEMOLITION line or where the 4"X 6"transition fitting is found. pW-SEW-REV 2.Contact the Wastewater Department at 360-403-3508 for inspections 24 hours in advance 12/09/2019 DEMOLITION PW-WAT-REV Fees Fee Description Notes Amount Demolition $100.00 Processing/Technology $25.00 State Surcharge- 1st DU Residential- 1st Unit $6.50 Credit Card Service $3.95 Total $135.45 Attached Letters Date Letter Description 12/11/2019 Building Permit 12/09/2019 Building Permit Payments Date Paid By Description Payment Type Accepted By Amount 12/12/2019 Craig Chase 78238105 $131.50 12/12/2019 78238105 CC Surcharge Raelynn Jones $3.95 Outstanding Balance $0.00 Notes Date Note Created By: 12/10/2019 Gus approved per phone conversation.At time of demo contact him for meter removal. Raelynn Jones Uploaded Files Date File Name 12/10/2019 5976374-314 N French-PS Clean Air Notification.pdf 12/09/2019 5968330-2927 Application and Asbestos Testing,pdf