HomeMy WebLinkAboutPermit File BLD-2022-0395 1920 R Avenue =` �►' ` C ''"._ City of Anacortes
Invoice/Permit#: BLD-2022-0395
904 6th Street
Applied date: 05/25/2022
P.O.Box 547
�'7► Issue date: 05/25/2022
Anacortes, WA 98221-0547
Expire date: 05/20/2023
Job Address: 1920 R AVE Permit Type: Commercial Demolition Permit
ANACORTES WA 98221-2377 Project:
APN: P32941
Remarks: Demolish industrial building.
Owner: MJB PROPERTIES LLC Contractor: ASCENDENT LLC
Address: 5050 1 STAVE S Address: PO BOX 1150
STE 102
SEATTLE WA 98134-2400 SUMNER WA 98390
Phone: (206)255-5153 Phone: (253)249-4238
License#:
General Information: Fees:
Dwelling Units 0 State Building Code Fee Comm 25.00
Demolition permit 60.00
Total Calculated: 85.00
Deposits/Receipts: 0.00
Total Due: 85.00
The issuance or granting of this permit shall not be construed to be a permit for,or approval of, any violation of this Code or any other ordinance or order of
the City, of any state or federal law, or of any order, proclamation, guidance advice or decision of the Governor of this State.To the extent the issuance or
granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or
federal law, or order, proclamation, guidance advice or decision of the Governor of this State, this permit shall not authorize such work and shall not be
valid. The building official is authorized to prevent occupancy or use of a structure where in violation of this Code, any other City ordinances of this
jurisdiction or any other ordinance or executive order of the City, or of any state or federal law,or of any order, proclamation,guidance advice or decision of
the Governor. The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect,
inaccurate or incomplete information, or in violation of any City ordinance, regulation or order, state or federal law, or any order, proclamation, guidance or
decision of the Governor.This permit becomes null and void if work or construction authorized is not commenced within 180 days or if construction work is
suspended or abandoned for a period of 180 days at any time after work is commenced. I have read and exam' application and know the same to
be true and correct.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY
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y PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
G Mailing Address:P.O. Box 547,Anacortes, WA 98221
` Office Location: 904 5th Street,Anacortes WA 98821
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- Phone: (360)293-1901
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DECONSTRUCTION & DEMOLITION PERMITS
A demolition permit is required for deconstruction/demolition of structures and decommissioning of
underground storage tanks. A demolition permit is required for partial demolitions of structures when
the proposed work is not otherwise covered by a building permit.
STRUCTURE TYPE
4.
X
Deconstruction / Demolition Permit
ai 3 u
R Submittal Requirement Checklist _0 E ° o
Q U O
CL LL
a �
Deconstruction/Demolition Permit Application Form—Page 3 x x x
Site Plan,drawn to scale,including the following:
Property lines, easements, footprint of all existing structures, labeled as proposed
to be demolished or retained,and all utilities that serve structures to be demolished,
including: potable water, sanitary and storm sewers, electric service, natural gas, x x x
and propane(as applicable).
Include proposed stormwater Best Management Practices to be employed during site
work for erosion control and provisions for long term stabilization of the site.
Documentation of approval by Northwest Clear Air Agency
Unless deemed exempt by the NWCAA,all city required demo permits also require a permit X X
from NWCAA. Go to http://nwcleanairwa.eov for more information.
Asbestos Survey and Remediation Report, if required by NWCAA x x
Prepared by a Washington State Certified Asbestos Abatement Contractor.
Pedestrian Safety Plan x
City of Anacortes Fire Department Special Purpose Permit for Tank Removal x
Photographs of the building if it is 50 or more years old
• Please include photos of all sides of the building's exterior architecture,and
unique interior details. x x
• Submit digitally by email to pcedc@cityofanacortes.org,on a thumb drive,or
printed paper copies with your permit application.
SEPA checklist
❑ (*Only required for structures with recognized historic significance or not exempted under
WAC 197-11-800(2)(g)). Check with PCED,360-299-1984,for assistance.
Submit Application Application Fee
Please send applications in PDF format to See the Land Use Permit Fee Schedule
build ingpermit@cityofanacortes.orEg
An email with a link to a file share site is also acceptable.
Paper copies may be requested after initial review.
Deconstruction/Demolition Permit Application Submittal Checklist
Updated December 2021 Page 1 of 4
BUILDING MATERIALS SALVAGE OPTIONS
Did you know that salvaging usable materials from your project can save money, conserve valuable
material and energy resources, and help preserve Anacortes history?
Instead of demolishing and taking materials to the landfill, please consider relocation, salvage, or
deconstruction. Here are several resources you may wish to consult while planning your project:
• The City of Anacortes Museum / Historic Preservation board can provide advice for researching
the property's history, suggest potential alternatives to demolition, and identify historically
significant architectural features of the structure that may be ideal for salvage during structure
removal. Please contact the Anacortes Museum at 360-293-1915 or
coa.m use um Pcitvofanacortes.or-_ for assistance.
• Contact your Habitat for Humanity Store at 360-428-9402 (httils://www.habitat.orkrestores/donate-
goods)and they may remove or transport usable building materials from your project and give you
a tax credit in exchange.
• Some private companies may offer full deconstruction services to remove an entire building.
A helpful resource is the Construction Recycling Toolkit published by Sustainable Connections
available on their website: htt s: sustainableconnections.or ro rams toward-zero-waste
GENERAL PROCESS OUTLINE
• Notify the Northwest Clean Air Agency in writing and obtain needed permits:
https:/Inwcleanairwa. ov/permits-and-services/asbestos-and-demolition .
• Call 811 (Call Before You Dig)to notify utility companies with potential facilities in the area of your
dig site. They will send a locater to identify these facilities.
• Gather needed information and submit a deconstruction / demolition permit application to the
City of Anacortes.
• After permit issuance, install erosion control Best Management Practices per plan.
• Ensure City water service is shut off.
• Cap side sewer per Anacortes Engineering Design Standards and call for an inspection (360-299-
1972).
• Notify other non-City utility service purveyors (gas, electricity, cable, etc.) to determine
requirements for service interruption or disconnection.
• Septic tanks must be pumped and abandoned per Skagit County Health Department
requirements.
• Any fuel tanks(above or underground) must be removed/decommissioned in accordance with
State regulations. Contact Anacortes Fire Department for a permit and inspection (360-293-
1925).
• Dispose of building and construction materials in an approved manner.
• Stabilize the site to prevent stormwater/erosion impacts to surrounding properties and streets.
Deconstruction/Demolition Permit Application Submittal Checklist
Updated December 2021
Page 2 of 4
PERMIT APPLICATION FORM
PROPERTY INFORMATION
PROJECT ADDRESS(STREET,SUITE#): ASSESSOR PARCEL NUMBER:
1920 R Avenuea P32916
TYPE OF STRUCTURE
❑ Single Family ❑ Multifamily,#of Dwelling Units: 0 Commercial/Industrial
❑ Duplex ❑ Other Use Type: ❑ Underground Fuel Tank
STRUCTURE INFORMATION
FOR BUILDINGS:
Description of Work: i Size of structure: ee _sq.ft.
Demolish Existing Industrial Building
------------
Method of Disposal: Date of original construction of structure:
Recycle & Landfill 1983
HISTORIC RESOURCES INFORMATION:
------------------------------------------------------ --------------------------------,----------------------------------------------------------------------------------
Is the structure listed on the City of Anacortes Local, i If identified prior to demolition,are you
State,or National register of historic places? 1 willing to salvage from the structure
historically significant architectural features?
YES* XNO
Designation: i YES XNO
--------------------------------------------------------------------------------------------------------------------------------------
*If yes,SEPA review is required prior to issuing a demolition permit.
Note: Check with the City of Anacortes Museum and/or the WA State Dept. of Archaeological and Historic
Preservation's WISSARD system to answer this question.
UTILITY&SERVICES DISCONNECTION/ INTERRUPTION INFORMATION
Identify which City services you would like to disconnect/stop:
-----r ----------------------------r--------------- ------------------------------------------
Water NDisconnect ❑Retain i Storm XDisconnect ❑Retain
-------------
Sewer i Disconnect Detain Garbage XDiscontinue Detain
For private utilities (gas, electricity, cable, etc.), you will need to contact the applicable companies if their
services are to be interrupted or disconnected.
FOR UNDERGROUND STORAGE TANKS:
DECOMMISSIONING TYPE:
Abandonment in place (Fire Dept.Approval required) ❑ Removal
Date of pump&rinse: N/A i Disposal Location:
Type of inert fill: —
Approximate age of tank: ICC Certification#:
Deconstruction/Demolition Permit Application Submittal Checklist
Updated December 2021
Page 3 of 4
PROPERTY OWNER INFORMATION
NAME: PHONE:
MJB Properties, LLC 2062555153
ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS:
5050 1 st Ave S, Suite 102, Seattle jblais@gmccinc.com
CONTRACTOR INFORMATION
NAME:* PHONE:
Ascendent, LLC 253-249-4238
CONTRACTOR'S BUSINESS LICENSES STATE LICENSE#: CITY OF ANACORTES
*All Contractors&Subcontractors must have a 602142311 ENDORSEMENT?
valid City of Anocortes business license prior to EXPIRATION DATE: YES [—]NO
doing work in the City. 9/$/2023
ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS:
106 Frontage Rd N, Pacific WA 98047 'ross ascdemo.com
FINANCING INFORMATION (Required if project valuation exceeds$5,000, per RCW 19.27.095)
Lender administering the construction financing or firm issuance a payment bond (if any)on behalf of
the prime contractor for the protection of the owner, if the bond is for an amount not less than 50%of
the total amount of the construction project (if owner is self-financing, please indicate).
Completion of this information may be deferred until permit issuance.
NAME: PHONE:
N/A
ADDRESS(STREET,CITY,STATE,ZIP):
CONTACT PERSON
Select one person the city will contact for anything related to this project:
QX PROPERTY OWNER CONTRACTOR OTHER(LIST BELOW)
NAME: PHONE:
ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS:
SIGNATURE
I hereby declare that I am either the owner of the property listed on this application,or the owner
of this property has authorized me to be their representative to act for them. I also declare under
penalty of perjury under the laws of the State of Washington that all of the statements and answers
contained herein, and the information submitted with this application form is in all respects,true,
correct, and complete to the best of knowledge and belief.
5/23/2022
SIGNATURE DATE
Deconstruction/Demolition Permit Application Submittal Checklist
Updated December 2021
Page 4 of 4
Approved Transaction https:Hsecure.pscleanair.org/Asbestos/Approved.aspx
pscleanair.org
Puget Sound Agency
Notification Case #: 202202444
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 # AYOA4DA58872
Transaction Date 05/23/22
Owner's Name MJB Properties LLC Phone (206) 255-5153
Project Street Address 1920 R Avenue
City Anacortes Zip 98221
Contact Person Jimmy Blais Phone (206) 255-5153
Mailing Address 5050 1st Ave S,Suite 102
Seattle,WA 98134
This project includes a demolition.
Demolition Start Date 06/15/22 Completion Date 12/31/22
Demolition will be completed by a demolition contractor
Demo Contractor Ascendent LLC Contractor Job # 2021-904
Contact Jon Ross Phone (253) 249-4238
Mailing Address 106 Frontage Road N
Pacific,WA 98047
(1) I certify that the information I have provided is to the best of my knowledge true and accurate.
(2) I understand that I must file an Amendment to this Notification if:
• The type of project has changed. The project types are asbestos and demolition.
• The quantity of friable asbestos to be removed meets a larger project category.
• The project's start or completion date has changed.
(3) I understand one Notification must be filed for each structure. The only exception is for
a single-family residence that includes multiple ancillary structures, such as a detached
garage or other outbuildings having the same street address. If there is no street address, I
have used a building number.
(4) I understand the fees for this Notification are nonrefundable.
Create Another Notification
If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058.
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Asbestos Inspection Northwest
20675 State Route 534
Mount Vernon WA 98274
425.443.2031
Survey No. 5.20.22.1
Today's Date: 5.20.22
Client:Jimmy Blais
Email:jblais@gmccinc.com
RE:Asbestos Survey: 1920 R Ave Anacortes WA
On May 9th 2022, 1 inspected a commercial building(30,000 sq ft warehouse with 3 story office complex
[2300 sq ft] inside warehouse area), located at the above address,for the purpose of determining the
presence or absence of building materials that might contain asbestos.The purpose for the survey was
for demolition.Only the materials listed were sampled and tested. No other materials were sampled.
The interior of the warehouse section was structural steel with concrete wall and a metal roof.
Title 40 Code of Federal Regulations(40 CFR),subpart M,section 61.141,established the allowable limit
of asbestos in building materials at 1%by weight. Materials containing more than 1%asbestos are
regulated and must be handled in accordance with Federal,State, and Local regulations.
Surveys are based on "visible and accessible materials"and although reasonable effort was made to
locate and test all suspect materials,some suspect materials may remain hidden in walls or below floor
underlayment or other areas until demolition or renovation work makes them accessible. If other
suspect materials are discovered during the course of demolition or remodel activities,they will require
testing prior to continuing work.All square footages are estimates and should be verified by a
contractor prior to bidding.
#16 BULK SAMPLES were collected, and #16 samples was subsequently analyzed for asbestos content by
Polarized Light Microscopy(PLM) at CEI Labs in Cary North Carolina.All samples were negative for the
presence of asbestos.
This letter along with the attached material list and lab report will comprise the "Asbestos Survey".
Please call or email if you have questions.
All the best,
Douglas Boze
AHERA Building Inspector
Certification#181819 (expires June 16th, 2022)
21905 64th Ave W,#100 ■ D
Mountlake Terrace,WA 98043 ®n
(206)285-3373 ■r Ar�=
This certifies that TR NING•CONSuvnNG(1
Douglas E. l3oze "16"m""""
has satisfactorily completed
4 hours of online refresher training as an
AHERA Building Inspector
to comply with the training requirements of
TSCA Title II,40 CFR 763(AHERA)
_ EPA Provider#1085
Instructor.Andre Zwanenburg Date:Jun 16,2021 Expires in 1 year.
Cert Num:181819
ti eurofins
CEI
May 13, 2022
Asbestos Inspection NorthWest
20675 State Route 534
Mount Vernon, WA 98274
CLIENT PROJECT: 1920 12 Ave, Anacortes
CEI LAB CODE: A223790
Dear Customer:
Enclosed are asbestos analysis results for PLM Bulk samples received at our laboratory on
May 12, 2022. The samples were analyzed for asbestos using polarizing light microscopy
(PLM) per the EPA 600 Method.
Sample results containing >1% asbestos are considered asbestos-containing materials
(ACMs) per EPA regulatory requirements. The detection limit for the EPA 600 Method is <1%
asbestos by weight as determined by visual estimation.
Thank you for your business and we look forward to continuing good relations.
Kind Regards,
Tianbao Bai, Ph.D., CIH
Laboratory Director
P4vt
TESTING
NVLAP LAB CODE 101766-0
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413
tiff eurofins
CEI
ASBESTOS ANALYTICAL REPORT
By: Polarized Light Microscopy
Prepared for
Asbestos Inspection NorthWest
CLIENT PROJECT: 1920 12 Ave, Anacortes
LAB CODE: A223790
TEST METHOD: EPA 600 / R93 / 116 and EPA 600 / M4-82 / 020
REPORT DATE: 05/13/22
TOTAL SAMPLES ANALYZED: 16
# SAMPLES >1% ASBESTOS:
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413
• ti Asbestos Report Summary
tiff e u rof i n s By: POLARIZING LIGHT MICROSCOPY
PROJECT: 1920 12 Ave, Anacortes LAB CODE: A223790
METHOD: EPA 600/ R93 / 116 and EPA 600/ M4-82/020
ASBESTOS
Client ID Layer Lab ID Color Sample Description %
HM1 A223790.01A Blue Vinyl Flooring None Detected
A223790.01 B Clear Mastic None Detected
HM2 A223790.02A Gray Cove Base None Detected
A223790.0213 Beige Mastic None Detected
HM3 A223790.03 Gray Vinyl Flooring None Detected
HM4 A223790.04 White Sink Undercoating None Detected
HM5 A223790.05 Off-white,White Drywall/Joint Compound None Detected
HM6 A223790.06A Gray Vinyl Flooring None Detected
A223790.066 Yellow Mastic None Detected
HM7 A223790.07A Gray,Black Carpet None Detected
A223790.0713 Yellow Mastic None Detected
HM8 A223790.08 Off-white,White Drywall/Joint Compound None Detected
HM9 A223790.09A Gray Vinyl Flooring None Detected
A223790.096 Gray Mastic None Detected
HM10 A223790.10 Silver Wind Breaker None Detected
HM11 A223790.11 Off-white Insulation None Detected
HM12 A223790.12 Yellow Foam None Detected
HM13 A223790.13 Gray Sealant None Detected
HM14 A223790.14 Gray Expansion Joint None Detected
HM15 A223790.15 Black Rolled Roofing None Detected
HM16 A223790.16 Gray Concrete None Detected
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413 Page 1 of 1
eurofins ASBESTOS BULK ANALYSIS
'ti.• CEI By: POLARIZING LIGHT MICROSCOPY
Client: Asbestos Inspection NorthWest Lab Code: A223790
20675 State Route 534 Date Received: 05-12-22
Mount Vernon, WA 98274 Date Analyzed: 05-13-22
Date Reported: 05-13-22
Project: 1920 12 Ave, Anacortes
ASBESTOS BULK PLM, EPA 600 METHOD
F
ent ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS
ID Description Attributes Fibrous Non-Fibrous %
HMI Vinyl Flooring Heterogeneous 10% Fiberglass 30% Vinyl None Detected
A223790.01A Blue 60% Foam
Fibrous
Bound
A223790.01 B Mastic Heterogeneous 5% Cellulose 95% Mastic None Detected
Clear
Fibrous
Bound
HM2 Cove Base Homogeneous 100% Vinyl None Detected
A223790.02A Gray
Non-fibrous
Bound
A223790.02B Mastic Heterogeneous <1% Cellulose 95% Mastic None Detected
Beige 5% Binder
Fibrous
Bound
HM3 Vinyl Flooring Heterogeneous 30% Cellulose 50% Vinyl None Detected
A223790.03 Gray 20% Fiberglass
Fibrous
Bound
HM4 Sink Undercoating Heterogeneous 5% Cellulose 95% Binder None Detected
A223790.04 White
Fibrous
Bound
HM5 Drywall/Joint Heterogeneous 20% Cellulose 70% Gypsum None Detected
A223790.05 Compound Off-white,White 5% Fiberglass 5% Calc Carb
Fibrous <1% Paint
Bound
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413 Page 1 of 4
4:k eurofins ASBESTOS BULK ANALYSIS
CEI By: POLARIZING LIGHT MICROSCOPY
Client: Asbestos Inspection NorthWest Lab Code: A223790
20675 State Route 534 Date Received: 05-12-22
Mount Vernon, WA 98274 Date Analyzed: 05-13-22
Date Reported: 05-13-22
Project: 1920 12 Ave, Anacortes
ASBESTOS BULK PLM, EPA 600 METHOD
Client ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS
Lab ID Description Attributes Fibrous Non-Fibrous %
HM6 Vinyl Flooring Homogeneous 100% Vinyl None Detected
A223790.06A Gray
Non-fibrous
Bound
A223790.06B Mastic Homogeneous 100% Mastic None Detected
Yellow
Non-fibrous
Bound
HM7 Carpet Homogeneous 100% Synthetic Fiber None Detected
A223790.07A Gray,Black
Fibrous
Bound
A223790.07B Mastic Heterogeneous <1% Synthetic Fiber 100% Mastic None Detected
Yellow
Fibrous
Bound
HM8 Drywall/Joint Heterogeneous 20% Cellulose 70% Gypsum None Detected
A223790.08 Compound Off-white,White 5% Fiberglass 5% Calc Carb
Fibrous <1% Paint
Bound
HM9 Vinyl Flooring Homogeneous 100% Vinyl None Detected
A223790.09A Gray
Non-fibrous
Bound
A223790.098 Mastic Heterogeneous <1% Cellulose 100% Mastic None Detected
Gray
Fibrous
Bound
730 SE Maynard Road • Cary, NC 27511 - 919.481.1413 Page 2 of 4
eurofins ASBESTOS BULK ANALYSIS
ti• CEI By: POLARIZING LIGHT MICROSCOPY
Client: Asbestos Inspection NorthWest Lab Code: A223790
20675 State Route 534 Date Received: 05-12-22
Mount Vernon, WA 98274 Date Analyzed: 05-13-22
Date Reported: 05-13-22
Project: 1920 12 Ave, Anacortes
ASBESTOS BULK PLM, EPA 600 METHOD
Client ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS
Lab ID Description Attributes Fibrous Non-Fibrous %
HM10 Wind Breaker Heterogeneous 95% Vinyl None Detected
A223790.10 Silver 5% Metal Foil
Non-fibrous
Bound
HMI Insulation Homogeneous 100% Fiberglass None Detected
A223790.11 Off-white
Fibrous
Loosely Bound
HM12 Foam Homogeneous 100% Foam None Detected
A223790.12 Yellow
Non-fibrous
Bound
HM13 Sealant Homogeneous 100% Binder None Detected
A223790.13 Gray
Non-fibrous
Bound
HM14 Expansion Joint Homogeneous 100% Binder None Detected
A223790.14 Gray
Non-fibrous
Bound
HM15 Rolled Roofing Heterogeneous 40% Fiberglass 45% Tar None Detected
A223790.15 Black 5% Cellulose 10% Gravel
Fibrous
Bound
HM16 Concrete Heterogeneous 60% Silicates None Detected
A223790.16 Gray 35% Binder
Non-fibrous 5% Paint
Tightly Bound
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413 Page 3 of 4
tiff eurofins
rr�
LEGEND: Non-Anth = Non-Asbestiform Anthophyllite
Non-Trem = Non-Asbestiform Tremolite
Calc Carb = Calcium Carbonate
METHOD: EPA 600/ R93/ 116 and EPA 600/M4-82 /020
REPORTING LIMIT: <1% by visual estimation
REPORTING LIMIT FOR POINT COUNTS: 0.25% by 400 Points or 0.1% by 1,000 Points
REGULATORY LIMIT: >1% by weight
Due to the limitations of the EPA 600 method, nonfriable organically bound materials (NOBs) such as
vinyl floor tiles can be difficult to analyze via polarized light microscopy (PLM). EPA recommends that
all NOBs analyzed by PLM, and found not to contain asbestos, be further analyzed by Transmission
Electron Microscopy (TEM). Please note that PLM analysis of dust and soil samples for asbestos is
not covered under NVLAP accreditation. Estimated measurement of uncertainty is available on
request.
This report relates only to the samples tested or analyzed and may not be reproduced, except in full,
without written approval by Eurofins CEI. Eurofins CEI makes no warranty representation regarding
the accuracy of client submitted information in preparing and presenting analytical results.
Interpretation of the analytical results is the sole responsibility of the client. Samples were received in
acceptable condition unless otherwise noted. This report may not be used by the client to claim
product endorsement by NVLAP or any other agency of the U.S. Government.
Information provided by customer includes customer sample ID and sample description.
ANALYST: aF gp5S APPROVED BYE
Rosa In —ac ruz Tianbao Bai, Ph.D., CIH
Laboratory Director
Scott Minyard
r4vtQ
TESTING
NVLAP LAB CODE 101768•'
730 SE Maynard Road - Cary, NC 27511 - 919.481.1413 Page 4 of 4
ASBESTOS
CHAIN OF CUSTODY
C io.k USE GIJ
730 SE Maynard Road,Cary, NC 27511 C61 ab-ddde: 4
Tel: 886481-1412; Fax 919-481-1442 CEI aWLD
CS WENT job Contact Douglas Boze
Company: Asbestos Inspection NW Email/Tel: 425.443.2031
Address: 20676 State Route&U Project Name: 07n
I , -
Mount Vernon WA 98274 Project Im. -i^A
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Version: CCOC.01.17.IJ2.LD
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Company-. Asbestos Inspection NW Job Contact: Douglas Boze
Pro ect Name: 117,19
Pr 'ect ID#: S Tel: 426.443.2031
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Page of
Version: CCOC.01.17.212.LD
Asbestos Inspection Northwest
20675 State Route 534
Mount Vernon WA 98274
425.443.2031
Client:Jimmy Blais
Survey Number: 5.20.2022.1
Date of Survey: 5.9.2022
Asbestos Survey Address: 1920 R Ave Anacortes WA
Material# Location of Type Friable? Condition Quantity Sample Asbestos
and area Location
Description
HM 1 blue Top floor Misc Yes Intact 594 sq ft Center of ND
vinyl of office cafeteria
area,
cafeteria
HM 2 gray Stairwell Misc Yes Intact 100 lineal Stairwell ND
cove base and feet
with yellow bathrooms
mastic
HM 3 gray Kitchen Misc Yes Intact 694 sq ft Center of ND
speckled and stair kitchen
vinyl landing
area,2"d fl
office and
closet
HM 4 white Kitchen, 3rd Misc No Intact 3 sq ft Sink ND
sink floor
undercoating
HM 5 Through Misc Yes Intact 500 sq ft Kitchen ND
drywall out 3rd SW corner
floor wall, left
of entry
HM 6 gray Stairwell Misc Yes Intact 300 sq ft 2nd stair ND
vinyl with on 2nd
yellow story rise
mastic
HM 7 short 2"d story Misc No Intact 414 sq ft North ND
gray carpet office entry
with yellow
mastic _
NOTE: Friability assessments were made on these materials in their present, undisturbed condition on
the survey date,AS IS. Damage or disturbance of any kind may cause some non-friable materials to
become friable.
HM 8 211 floor Misc Yes Intact 500 sq ft Storage ND
drywall closet NW
corner
HM 9 light 11x11 Misc Yes Intact 511 sq ft NE corner ND
gray vinyl office on of mens
ground fl, bathroom
mens
bathroom
and 18x20
se office
HM 10 silver Ground Misc Yes Intact 1008 sq ft South ND
shield with level,at door
foam garage
doors
HM 11 white Ground Misc Yes Intact 576 sq ft Ground ND
insulation floor, level
warehouse,
east wall,
middle
HM 12 Crack Misc Yes Intact 100 lineal SE entry ND
orange foam sealant feet
interior
and
exterior
HM 13 gray Exterior Misc No Intact 162 lineal SE ground ND
window windows feet floor
sealant window
HM 14 Vertical Misc No Intact 600 lineal 3`d pillar ND
expansion exterior feet from
joint gray expansion south on
caulk joint east
exterior
end by
garage
door
HM 15 black Eve over Misc Yes Intact 84 sq ft SE corner ND
rolled roof hang on
exterior SE
corner
HM 16 Exterior Misc No Intact TBD SE corner ND
cement columns
NOTE: Friability assessments were made on these materials in their present, undisturbed condition on
the survey date,AS IS. Damage or disturbance of any kind may cause some non-friable materials to
become friable.