2006, 09-01 Permit Application: 06003519 Demo Accessory Bldg4
Spokane
Valley
Community Development
Demolition
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
www.spokanevalley.org
Notice of Intent
Permit Application # - r
SITE ADDRESS:
ASSESSORS PARCEL NO:
Building Owner:
Name:
Iiitid
Address: 7 -U l C it%ki
City: 5,0A-an -Q tA %
State: uv, 1
Zip: ��zil
Phone: 9 7 ? _� (
Fax:
Contact Person
Name:
Phone: ?75 - /
PERMIT NUMBER: 557 9
PERMIT FEE: "Ci —
Commercial
Residential
Contractor:
Name: I�
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
Describe the scope off work in detail* * * *NOTI E OF INTENT REQUIRED *
/lrJ/Lt411 QAi) c/iJpo e 4 c2 Ieecylk
Cost of project: $ 774-r iCeJ iteyc X 17 U
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is /will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or
additional information may be required to be submitted, and subsequently approved before this application can be
processed.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signature i
Method of Pay nt:
❑ Cash
Bankcard #:
Authorized Signature:
REVISED 8/23/2005
did
❑ Check
Date 771
❑ Mastercard ❑ VISA
Expires: VIN #:
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NOTICE OF INTENT'
(NOI) TO PERFORM:
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.A.
A. Project Type:
1 1. • Asbestos Removal
2. ❑ Asbestos Removal & Demolition
34 Dffaiditia0/103160111Rtnedlaufl
B. Property — ----add
Owner: I �4 /U�it(�'
/
Phone: F? ?�C� 66/
(If available)
Fax:
Property Owner's ,r G
Mailing Address: W ,11t r
City: �J t4gy
State:04
Zip: P2/
C. Site
Address: 7f0 f(/
A 7 r 47
City: !/ ' /
State: elil7t -
Zip: 2-(�—
Responsible Site
Contact Person:
Job Sire
Phone:
D. Asbestos Survey or
• Material Presumed
If survey erformed, was asbestos found?
Q Yes . If No, Attach Survey
Date Survey %l
Conducted: trf�
No. of Structures:
(see back if >1)
AHERA Building
Inspector Name: i�- �rdGbl -e six-,c-�-o=
Certification rr
Number: 3 "05- Z2-- -1
Exp.
Date: /�� d,o
E. Asbestos Project
Information:
No. of Structures:
(see back if >I)
Start
Date:
Completion
Date:
Wk. Days: Su M T W Th F Sa
.Hours:
Wiltwork schedule tJYes
fax pgiu be used? ❑ No
Total quantity
to be remove:
La.
Feet
Sq.
Feet
Will all asbestos material be ❑ Yes
removed by project completion? ❑ No
List individual typo and of materials to
-- _._._ - - --
quantity
be removed or provide an attachment of same:
Abatement
Contractor:
Phone:
Fax:
Mailing
Address:
Ci :
State:
Zi•:
F. Demolition
Information:
No. of Structures:
(sec back if > 1)
Start -
Date:
L7 Training Fire (List Fire Dept. as demo. contractor below)
❑ Ordered Demolition (attach copy of Order)
Demolition cl lZ
Contractor: S'' 1 Nl 1-...
Phone:
Fax:
Mailing J
Address: �tle�i
City: '"�''i-
�4,2
State.
Zi p:
G. Asbestos/Demolition olition Project Categories: �
oj �,
Does is ect involve a fire -dams cd structure? ❑ Yes No
Notification
Waiting Period
-- '
Pnor Notice
Non- Refundable
Project Fee
—' ' s
_ $30�
1. • wner- Occupied Residential Asbestos Removal & Demolition Project *
A Owner - Occu•ied Residential Demolition Prosect Onl a �__
Z • All Other Demolitions With No Asbestos Removal Project
10 Days
3 Da
S250
$250
—71-1 10 - 259 linear feet or 48 - 159 square feet see back of forth for o•lions
4. ■ 260 - 999 linear feet or 160 - 4,999 square feet
10 Days
10 Days
$500
$1,250
5. • > 1,000 linear feet or> 5,000 s• wire feet
6. • Emer• encv Asbestos Project or Emer'enc Demolition Proect
Prior Notice
Twice Project Fee
7. • Alternate Means of Compliance for Friable Materials or • Demolition
10 Days
Twice Project Fee
8. • Alternate Means of Compliance for Nonfriable Asbestos Materials
10 Days
Twice Project Fee
9. ❑ Exception for Hazardous Conditions
Concurrent with Project
Regular Project Fee
« The two categories in G.l apply only to owner-occupied, single - family residences, which means any non - multiple un t building containing living
space that is currently occupied (prior to and after renovation/demolition) by one family who owns the property as their domicile. One of the
• -: oriel to G.2 -9 must be used for all other renovation/demolition . to ects. For more information. contact SCAPCA at 509 477 -4727.
1L Optional: List additional panics you would like copies of this NO! and/or related notices sent to (list name & fax number and/or mailing address):
I. I certify that the information contained in this notification and any supplemental data provided is, to the best
of my know ge, acG to complete.
t • T • = t�k''; ^ .4:
,�, 'y. ` ;',4
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Y i,v,Vi .'ik •
Signature Representing Date
Your advance notification period will begin when a goingliaellNOI, including required fees, is received by SCAPCA.
copy ate asbestos survey, completed notification & all amendments must be available for inspection at all times at the job site. Nor 8/06
SEP 01 2006 13:20
5094776828 PAGE.01
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