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20160118 Permit Pkg 01292016City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: ADVANCE ENVIRONMENTAL Address: 3620 49TH AVE SW OLYMPIA WA 98512 Property Information: Site Address: An7 VGI M A \19 C Assessor Parcel No.: Contractor Information Name: ADVANCE ENVIRONMENTAL Address: 3620 49TH AVE SW OLYMPIA WA 98512 Contractor License No.: Subdivision: Permit No.: 20160118 Issue Date: 1/2912016 (Work must be completed within 180 days) Phone: Owner: STAN CARLSON Phone: Expires: 0 /00 /0000 Project Information: Project: DEMOLITION Description of Work: DEMO OF ALL BLDGS ON PROPERTY Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): Second Third Garage Basement Fees: Item DEMOLITION Contractor ADVANCE ENVIRONMENTAL TOTAL FEES: Applicant's Affidavit: I certify that I have read and examined the information contained within the application and know the same to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants, easements and restricts record lying as a contractor, I further certify that I am currently registered in the Stat o as ton Signature A Date Firm 404PV*i1 & -C_ .Q it ✓� �iQG'tIN d94 4 I lie Lot: Fees $ 50.00 $ 50.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: City of Mm (36 ) 458 -3244 REC #: 00220680 1/25/2016 12:00 PM OPER: CO TERM: 001 REF #: PAID BY: ACCT #: XXXXXXXXXXXXXXXXXXX AUTH #: 345820 TRAN #: 000000004780 TRAN: 33.0000 BUILDING PERMITS 20160118 50.O(CR ADVANCE ENVIRONMENTIL 407 YELM AVE E DEMO 50.0(CR TENDERED: 50.00 CREDIT CARD APPLIED: 50.00- CHANGE: 0.00 n CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address: �4&-I;:'- , Y6-121 _ t Parcel #: Subdivision: Lot #: Plan #: Zoning: _ New Construction Re -Model / Re -Roof / Addition Home Occupation Sign Plumbing Mechanical Mobile/ Manufactured Home Placement Other Project Description /Scope of Work: .1),e- 44u b PIL All S1y_cj(` _e -s v K Project Value: Building Area (sq. ft) 1" Floor ' n,- 2 I Floor 7cc Garage V e-5 Deck_...A)_A4__ Basement - 5' Carport ZZ4,z Patio /Lrg- # Bedrooms # Bathrooms Heating: GAS /OTHER or ELECTRIC (Circle One) Are there any environmentally sensitive areas located on the parcel? If yes, a completed environmental checklist must accompany permit application. BUILDING OWNER NAME: 14IJ12_ y ,-7 z ✓t ADDRESS %/ e �,v, ', � EMAIL CITY STATE ZIP TELEPHONE ARCHITECT /ENGINEER LICENSE # ADDRESS EMAIL CITY STATE ZIP TELEPHONE GENERAL CONTRACTOR i%AA) l/ &'r(J TELEPHONE -3 r cs 6� 7 ADDRESS �rJ EMAIL ,Ao4V* -,vc- e_,� CITY STATE L-04—ZIP AX _2C e> .3 S 2 S C G S CONTRAC OR'S LICENSE #A-l��vG_ y7ly <P DATE CITY LICENSE # PLUMBING CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # MECHANICAL CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # Copy of mitigation agreement with Yelm Community Schools, if applicable. 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 State of Washington and the City of Yelm. Ap licant's Signature Date Owner / Contractor / Owner's Aaent / Contractor's Aaent (Please circle one_► All permits are r h permit is not begun within 180 days Z m o • period of 180 days LLJ 6° N O O�'O C . N y Y c >0 N C 7 0f OC y - CL 105 Yelm Avenue If Q W (360) 458 -3835 Yelm, WA 98597 0 W (360) 458 -3144 FAX www.ei.yelm.wa.us GIt } "�' Olympic Re ion Clean Air Agency NQ g g Y 2940 Limited Lane NW , `% Olympia, WA 98502 f (360) 539 -7610 - FAX (360) 491 -6308 South Bend Office (360) 942 -2137 �m f Port Townsend Office (360) 338 -6419 a • www.ORCAA.org PROPERTY OWNER Name: Stanley Carlson Mailing Address: 11212 Greystone Dr SW Site Contact Person: Genaro Magana Site Address: 407 E Yelm Ave ASBESTOS CONTRACTOR Contractor Name: Advance Environmental Mailing Address: 3620 49th Ave SW PROJECT INFORMATION Contractor Asbestos Permit Phone: (253) 584 -3144 Email: City: Lakewood State: WA Zip: 98499 Phone: (360) 357 -5666 Email: advanceenviron mental @com City: Yelm County: Thurston Zip: 98597. Phone: (360) 357 -5666 Email: advanceenvironmental City: Olympia State: WA Zip: 98512 Start Date: Completion Date: Work Shift Days: Work Shift Hours: 1/28/2016 1/29/2016 M ❑ T F-1 W ❑ Th n F W Sa ❑ Su ❑ 8am -4pm # Structures to be Abated: 11 , Total Quantity to be Removed Square Feet: 350 Linear Feet: 0 Disposal Site: Thurston County WARC Will all identified asbestos be removed from structure? Will this structure be demolished after asbestos removal? Yes ❑No Yes [-]No Material(s) being removed: Project Category other ❑ Annual ❑ Emergency I do certify that I am the owner, authorized agent of the owner, or authorized contractor for the property subject to this ORCAA application /permit. I authorize ORCAA staff to enter the property listed in this application at reasonable times for purposes of inspecting the work that is the subject of this application /permit and to ensure compliance with permit conditions, applicable laws and regulations. I understand that granting of this permit by ORCAA does not authorize anyone to violate federal, state, or local laws or regulation pertaining to activities associated with this permit. I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do certify under penalty of perjury under the laws of the state of Washington that the information in this application and supplemental data is, to the best of my knowledge true, accurate and complete. Electronically submitted by: advanceenvironmental @comcast.net Permit Conditions Date Application Received Payment Info. L�1 Approved Asbestos Permit: Total Fee: $325.00 ❑ Disa pproved Permit # 16ASB005131 Demolition Permit: 1/13/2016 Receive date: 1/13/2016 Review date: 1/25/2016 Permit # 16DEM004263 Reviewed by: TG Survey: W Yes ❑No Agency Use Only Agency Use Only Agency Use Only Agency Use Only OVER Olympic Region Clean Air Agency Completion . 2940 Limited Lane NW r! Olympia, WA 98502 (360) 539 -7610 • FAX (360) 491 -6308 Notification and C! RC South Bend Office (360) 942 -2137 �ss4. „" Y Port Townsend Office (360) 338 -6419 Amendment Form www.ORCAA.org Completion Notification - Actual Completion Date 1/29/2016 [ ] I" Amendment (no fee) [ ] 2 "d Amendment (no fee) [ ] Amendment _ ($25.00 non - refundable fee for all additional amendments) ASBESTOS PERMIT # 16 ASB00 5131 PROJECT INFORMATION New Start Date: On Hold date: Off Hold date (also need new New Completion date: Mobile: ( ) Site Address: 407 E Yelm Avenue completion date): State: WA Additional Square Feet: Additional Linear Feet: New Work Shift Days: New Work Shift Hours: [ ] Credit Card T_ W Th_ F_ Sa_ Su_ Demolition Permit INM_ ew Disposal Site: Please provide the following information: PROPERTY OWNER Name: Stanley Carlson hone: ( 253)584 -3144 Email: ax: ( ) Mobile: ( ) Site Address: 407 E Yelm Avenue City: Yelm State: WA Zip: 98597 CONTRACTOR ( 1 Check if same as orotierty owner information Business Name: Advance Environmental Inc hone: ( 360) 357 -5666 Email: advanceenvironmenrtal @comcast.net ax: ( 366 357 -5665 Onsite Contact: Dan Venable hone: ( 360) 357 -5666 Mobile: ( ) ax: ( 360) 357 -5665 Additional Comments: I do certify that 1 am the owner, authorized agent of the owner, or authorized contractor for the property subject to this ORCAA application /permit. 1 authorize ORCAA staff to enter the property listed in this application at reasonable times for purposes of inspecting the work that is the subject of this application/permit and to ensure compliance with permit conditions, applicable laws and regulations. 1 understand that granting of this permit by ORCAA does not authorize anyone to violate federal, state, or local laws or regulation pertaining to activities associated with this permit. I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do certify under penalty of perjury under the laws of the state of Washington that the information in this application and supplemental data is, to the best of my knowledge true, accurate and complete. Tina M. Sturdevant Print Name WILSON- TIM 1/29/2016 Date Date Application Received Payment Info. ( ] Approved Asbestos Permit [ ] Cash [ ] Disapproved Permit # ASB00 [ ] Check: # [ ] Credit Card Review date: _ /_ /_ Demolition Permit Permit # DEM00 Receive date:_ /_ /_ Reviewed by: 11 en Use Onl ni ii c Agency Use Only zlXency Use Only ng Use Onl vli l.) OVER Olympic Region Clean Air Agency 'rP 2940 Limited Lane NW Olympia, WA 98502 3,t (360) 539 -7610 - FAX (360) 491 -6308 South Bend Office (360) 942 -2137 .` RCA-A Port Townsend Office (360) 338 -6419 ata, www.ORCAA.org Emergency PROPERTY OWNER Name: Stanley Carlson Mailing Address: 11212 Greystone Dr SW Site Address: 407 E. Yelm Ave DEMOLITION CONTRACTOR Contractor Name: Advance Environmental Site Contact Person: Dan Venable Demolition Permit Phone: (253) 584 -3144 Email: City: Lakewood State: WA Zip: 98499 City: Yelm County: Thurston Zip: 98597 Phone: (360) 357 -5666 Email: advanceenvironmental Phone: 360 357 5666 DEMOLITION INFORMATION # of structures being demolished: 1 Start Date: Asbestos present? 0 Yes �:INo Survey attached? Yes �:lNo DEMOLITION PROJECT CATEGORY W Complete Demolition El Training Fire Fire Agency, Contact, Phone: ❑ Renovation, Alteration, Remodeling, Maintenance, or other Construction 2/1/2016 Expiration Date: 1/31/2017 All identified asbestos was removed under Asbestos Permit # 16ASB005131 I do certify that I am the owner, authorized agent of the owner, or authorized contractor for the property subject to this ORCAA application /permit. I authorize ORCAA staff to enter the property listed in this application at reasonable times for purposes of inspecting the work that is the subject of this application /permit and to ensure compliance with permit conditions, applicable laws and regulations. I understand that granting of this permit by ORCAA does not authorize anyone to violate federal, state, or local laws or regulation pertaining to activities associated with this permit. I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do certify under penalty of perjury under the laws of the state of Washington that the information in this application and supplemental data is, to the best of my knowledge true, accurate and complete. Electronically submitted by: advanceenvironmental @comcast.net Permit Conditions Date Application Received Payment Info. Approved Asbestos Permit: .Permit # 16ASB005131 Total Fee: $60.00 Disapproved Demolition Permit: 1/13/2016 Receive date: 1/13/2016 Review date: 1/25/2016 permit # 16DEM004263 Reviewed by: TG Agency Use Only Agency Use Only Agency Use Only Agency Use Only OVER