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C I _TY aF' ARL I hlGTQtV
CONST RUC-" I ON FEE RM I -U
PEFRM I T h!O _ _ 106 -68c38
Ovtner: RIDGEWOOD HOMES P O BOX 969 MARYSVILLE 98270
Value of Work: Tax ID: 31052300300600 Phone: 360-653-3848
Describe Work: DEMOLITION
Proposed Use: DEMOLITION
Legal Description:
Job Address: 17611 67TH AVENUE NE
Contractor's Name Type Address License#
RIDGEWOOD HOMES GEN 13225 11TH AVE NE RIDGEH*088MU
TOTALS Fee
Permit Fee $100. 00
State fee $4. 50
SIGNATUR'�
TOTAL FEE. . . . . . . . . . . . . . . . . $104. 50 I HEREBY FY TH 1' I AVE READ
AND EXAMINED THIS APPLI ATION AND
PAYMENTS. . . . . . . . . . . . . . . . . . $0. 00 KNOW THE SAME TO BE TRUE AND COR-
RECT ALL PROVISIONS OF LAWS AND
TOTAL DUE. . . . . . . . . . .. . . . . . . $104. 50 ORDINANCES GOVERNING THIS TYPE OF
W RK WILL BE COMPLIED WITH WHETHER
S DATE RECEIPT # ECIFIED HEREIN OR NOT.
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���Y DEMOLITIOI .
7 PERMIT APPLICATION
��fNG�� Department of Community Development
City of Arlington • 238 N Olympic Ave. •Arlington, WA 98223 • Phone (360) 403 3431 • FAX (360)403 3447
THIS APPLICATION MUST BE ACCOMPANIED TWO(2)SETS OF FULLY DIMENISIONED PLOT PLANS AND SITE CLEAN-UP
PLAN, TWO(2) COPIES OF AN ASBESTOS ABATEMENT REPORT COMPLETED BY AN APPROVED AGENCY.
Type of Permit: (check one) residential ( )Commercial
Project Address: 17X II 67ri� y� /VC- ' /qRC Parcel ID#:
Lot#: Subdivis'on: /1l«Eon .SIWWc 7_ PLAT
Building Area Sq Ft) S No. of floors: Number of Buildings:
Owner: sr/.��E /4/ /V,41ye!z LS''nn�hI�NSOnf• Phone Number: 360 — 653-
Address: / '� OX :ity: 01 � State: WA Zip Code: 2 Z 70
Contact Person: hF/4 �UN�64�' bone Number:
Cell Phone: 7 /Vy Fax: 366- 6.57"Z1/(f
Address: City: State: Zip Code:
Scope of Work:
Contractor: AMA"WC 40 171Q1710544�—S -LAC Phone Number: 3�/ —�S3 '38�fIt
Address )027 90A- City: � ��l �� State:- W N Zip Code: /FZ70
Contractor's License Number: 0116C-y1a 3-?MP Expiration: 7'/7— 2760-7
1 hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above-
described property will be in accordance with the laws, rules and regulations of the Stat of Washington.
Applicants tgnature Date RECEIVED
Print Applicants Name
C O,A PERMIT C�°'°? o
FOR STAFF USE ONLY
Permit# Accepted By Amount Received Receipt# Date Received
WEB Forms—14 Page 1 of 1 5/05 dwa
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City of Arlington
Develo ment ServicesOA
yy.
Permit Center
REQUEST FOR REVIEW
NAME: z �1 BP #: 06- In Yj
DATE: I RETURN THIS FORM BY:
PROJECT SUMMARY:
RESPONDING DEPARTMENTS
TOM C., FIRE DAVE A. BUILDING
KAREN L., UTILITIES KERRY W., BUILDING
DERYL T., MARYSVILLE UTIL SCOTT B., BUILDING
BILL B., NATURAL RESOURCE YVONNE P., PLANNING
GREGG E., ENGINEERING CWA., CONSULTANT
SHERRI PHELPS, BUS LIC JIM T., CONSULTANT
SUBMITTAL INFORMATION IS ATTACHED. Please review the information and return this form and your
comments in memo form. If you have no comments, please return the form with the "No Comments"box
checked.
PLEASE MARK ONE BOX, SIGN, DATE,AND RETURN THIS FORM TO PC
❑ COMMENTS FOR THIS REVIEW ARE IN ATTACHED MEMO
r NO COMMENTS FOR THI� REVIEW, OKAY
OKAY TO ISSUE PERMIT ,L L
6 01 -Q G-! />/ ►J l�c /, i'! r r.�S S N;•r1c° c�. .,/ 77—
❑ COMMENTS
REVIEWED BY l DATE `'
0 0
Kerry Wentz
From: Kerry Wentz
Sent: Monday, March 06, 2006 4:54 PM
To: Bill Blake
Cc: Brad Collins
Subject: Demo permit for 17611-67th Ave NE
I am returning part of this submittal for an additional permit number. Each building must have a separate permit. I am
issuing permit#06-6898 for building "A" only. Bldg "B" needs a new permit# before I can issue it.
1
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.ASBESTO-TEST, INC.
TSTOS SURVEY
/ I T Y ate, 17609 67`h Ave. NE,
14l 5 `on, WA 98223
Page I of 4
A#260101
dPi9Mi,'cN4
January 30,2006 ,s-..��
Ridgewood-Homes; s
VED
PO BOX 969 1-- <06 BY
Marysville,WA 98271
Attu- Shane NO CHANGES AUTHORIZE®
Ph: 425-327-1018 fax: 360-657-2112 1 UNLESS APPROVED BY THE
BUlLDING, INSPECTOR
_No1e: SmWks of suspect Asbestos Contaimoigifoafals were take,per AHER!praroca and analyzedfor the
presence of asbestos- THERE WAS NO ASBESTOS DETECTED MANY OF THE SAMPLES TAKEN.!f there it
any additional suVea AC{!located prior to or&wing devioUtion(=ch as,but not lunited ro,those matetfah listed
Of'the twi page of this report),that was not discovered in this survey,the mateHar(s)twist be preswwd Asbestos
Containing MaterAd unless tared otherwise by laboratory analysis
On January 19, 2006 Asbesto-Test personnel conducted an Asbestos survey(per
U-SXY-AJA.H.E.R.A. guidelines as designated and specified by Puget Sound Clean Air
Agency and Washington Slate)o the 2 jearages only an,77609 67"Ave NE Arlington
Snohonush County Washington 98223 This survey purpose is to identify any Asbestos
Containing Materials that may be present and will require professional rentoval prior to
demolition or renovation.
NARRATIVE OF FINDINGS
BASIC CONSTRUCTION: The garages sit behind a house that is not included in this survey.
The structures are both wood frame. Garage 2 has a composition roof. The roofing material was
sampled. The siding vapor barrier materials were also sampled from garage 2. Garage l has a
wood shake roof. There were no roofing or siding vapor barrier materials Iocated associated with
garage 1.
INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS:The interior arms of
both structures are wood. The floors concrete. The walls are wood_
A �7
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CONTINUE TOP44GE2 FEB 2 S' 2006
1429 Ave,U.PMB 9187,Snohomish,WA 98290 ph:206-914 SS00 fax:360-563-2469 page:206-540-2401
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Rage 2 of 4 January 30,2006
AB260101 Asbesto-Test,Inc. (206)914-5500
2 garages only C),17609 67ib Ave- NE,Arlington Snohomish County Washington 98223
INSULATION: The insulation material was sampled from garage#2.
ELECTRICAL SYSTEM: The electrical wiring insulation did not appear to be of the kind to
be ACM. The power may have been"on"at the time of the survey,thus sampling was not safe.
Any suspect electrical wiring Insulation or any suspect W(Thermal System Insulation)found
In, around or behind any located fuse or breaker boxes should be considered to be ACM
(Asbestos Containing Material), unless determined otherwise by laboratory analysis.
HEATING AND VENTILATION SYSTEM: There is no heating system m either structure.
Misc.: None.
ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None.
#of structures included in survey. two garages
Requested by:Shane @ Ridgewood Homes, LLC,Z—
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Analytical Chccnist,B.Sc.
Inspector, certified A.H.E.R.A.
certificate 01017333 (Expires 8124/06)
continue to page 3 A.T
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Page 3 of January 30,2006
AB260101 Asbesto-Test,Inc. (206) 914-5500
2 garages only Cad 17609 674k Ave. NE,Arlington Snohomish County Washington 98223
THERE WAS NO ASBESTOS DETECTED IN ANY OF THE SAMPLES TAKEN
1.0 insulation NAD fiberglass,
garage#2 cellulose
2.0 vapor barrier NAD cellulose,tar
garage#2 sampled from interior window areas
3-0 composition roofing NAD cellulose,tar,
&underlying materials fiberglass,
garage#2 non-fibrous materials
NOT TO SCALE
N
676 AVE NE G2
H—HOUSE NOT INCLUDED IN SURVEY
G1=GARAGE 1,GZ=GARAGE 2
continue to page 4
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Page 4 of 4 January 30,2006
AB260JOI Asbesto-Test,Inc- (206)914-5500
2 garaM only 6D 17609 67*Am NE,Arlington Snohomish County, Washington 98223
Some sample analyses listed pray be a representative analysis of indlvidrtal andseparate samplinp and analysis of homogenous
materials,asprescribed by A.H.F-R.A.protocol.
Samples taken are listed with theireorruponding analyses/fmbesras is detecud those samples containing asbestas are listed firs!
and noted with the initials"ACM".
lf.during demolition or renovation,any additional hidden or covered suspect materfals similar to those identified in the survey are
located(may include but not limited to:sheet vinyl flooring,rile flooring,wall or ceiltng texrurings or paints,concrete siding or
skirting,cirmew pipes,cement wallboar4 elecMcal cloth,electrical wiring Itcsularlon,thermal paper,wallboard,joint compounds,
vinyl rnll coverings,spackling cownpoun*,or any other suspect 7W(77wrrnal Sysim Irnrdatfon)),they should be treated as
Asbestau Containing MateriaLs untem determirwd to be non-osbratos by labo►alory analyii.
Vote:Aiboto-Test,ire.don not guarantee approximatioau of quantities or ACM,which may be listed Htith the ualysm It is
therefore recommended prvfemioaat abatttaent price and/or disposal quotes be obtained try inquiring as to fees per area of
specific ACM aaaterial(Le-square or!lacer,foot,etas or by on site LunstaeaL
Aay and all taaterials idendj ed as ACM in lhls report owsr be abated prior to ACM tafisetrrba nce,rewpa ion,or
demolition.All materials identified as ACM mart bepimfasionatty abated by a Ucarsed asbestos abeteanent
con&worprior to any distarrbantx
Analytical test method USEPA 600IR93111601(PLM);WAC 296-62-07753 App.J
RN: ACM signifies"Asbestos Containing Material"
PACM sigh i&cs"Pcesumcd Asbestos Containing Material'
CAB signifies"Conercto Asbestos Board"
< sign!fies-kss than"
TM sigma"llennal System Insulation'
HVAC sigtifm"Heating VentiWingAir-Conditioning"
NAD signifies"No Asbestos Detected"
••torte percent is the USEPA regulatory limit for asbestos in bulk samples.
PLM has been Vmowo to miss asbestos in small percentages of some samples,which contain asbestos,thus negative PLM results
cannot be guaranteed_ Floor tilts and wipes should be tested with SEM or TEM,to Insure analytical accuracy when reported is small
patccsttagcs.
Asbcsto-Tcs4 Inc.claims responsibility for sample content only.
END OFREPORT
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ASB]ESTO-.TEST, INC.
FAX COVER
Date: 1! 3
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# of pages including cover:
Attn:
Comments:
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CEL '�(206f'91�•-5500
PAG R (206) 5d0=T401 %I�IC4C icsTjoie s.
FAX: �360) 5b3-3�d4 AZLA CEIR*IED I�NSPIZ4MOR
1429 Avc.D-I'MQ 9187,Snohomish,WA 9d290 ph:206-914-5500 rnx:360-563-2469 page:206-5,48-2401
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G`�Y °r DEMOLITIO01
7 o PERMIT APPLICATION
ttNG� Department of Community Development
City of Arlington• 238 N Olympic Ave. • Arlington,WA 98223 • Phone (360)403 3431 • FAX (360)403 3447
THIS APPLICATION MUST BE ACCOMPANIED TWO(2)SETS OF FULLY DIMENISIONED PLOT PLANS AND SITE CLEAN-UP
PLAN, TWO(2) COPIES OF AN ASBESTOS ABATEMENT REPORT COMPLETED BY AN APPROVED AGENCY.
Type of Permit: (check one) VResidential ( ) Commercial
Project Address: 17611 /IBC— Parcel ID#:
Lot#: Subdivision:
Building Area(Sq Ft)4_41V ,322 No. of floors: Number of Buildings:
Owner: 14NU /VA^"e!Z,-0141V501\1 Phone Number: 360 65-3
Address: ;ity: 09ySVIVif State: _WA Zip Code: 99 Z 7d
Contact Person: S 4-Atj E OU done Number:
Cell Cell Phone: 7 Z�^�Z 7—,/0/ Fax: 3t J — 6 "Z�/� E-mail:
Address: City: State: Zip Code:
Scope of Work:
Contractor: AM14-wny 171or1,00'-4�s -Z^e Phone Number: ,=W -6S3 -38122?
Address: �OX 9d� City: ��� �' State: UM Zip Code: X82770
Contractor's License Number: ��6�y�0 3Z�� Expiration:
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 will be in accordance with the laws, rules and regulations of the Stat of Washington.
6
Applicants ignature Date
-5-114NE 0uA&_. f
Print Applicants Name
i FOR STAFF USE ONLY
Permit# Accepted By Amount Received Receipt# Date Received
WEB Forms—14 Page 1 of 1 5/05 dwa
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