2008, 08-20 Permit App: 08003254 DemolitionSpokane
V ley
SERI '
BY:
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B -3
Spokane Valley, WA 99206
Tel: (509) 688 -0036
Fax: (509) 688 -0037
permitcenter @sgokaneval lev.orq
(Staff Use Only)].
PERMIT NUMBER: k Jv `
PERMIT FEE:
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: d � S %} 5f X4/C � LE i , 4Jf1
ASSESSORS PARCEL NO.: mss/ /
BUILDING OWNER NAME: 13R J%g S
MAILING ADDRESS:
CITY:
676/ S, / R -
-5 fl Atli A)C 1201`41.Er
STATE: VII ZIP: 9 9'6y6
CONTACT PERSON NAME: =7 /1"k( E.
�/�, q, �/ ALL
PHONE: -so9 - ! aL_Lio�D 198 - ' 23 CELL:
CONTRACTOR NAME: Li9R514J D Eiyi a
MAILING ADDRESS: /?0. y 5-3 Se-
CITY: �j Jr'.�pp K) 4%L STATE: �+ j) fi
PHONE: 3-3- / / / FAX: 675s= 00T7
CONTRACTOR LICENSE No.: beiliSD,fl,e4 CLEXPIRES:
zip:
CELL:
CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
[XC Site Plan Provided vi . Notice of Intent #
❑ Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
53M
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) The 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.
Signature
Date:
Method of payment: ❑ Cash
Bankcard #:
Authorized Signature:
7 Check
❑Visa ❑ Mastercard
VIN #:
Effective October 28, 2007 Page 1 of 1
C: \Documents and Settings \HP_Owner \My Documents \My Completed Downloads \Demolition Permit App.1.doc
EAug, 19. 20083 2:33PV5093,SPOKANE CLEAN AIR
IRS ENVIRONMENTAL.-- _ -_.. -. N0, 5392 P. 1:
Your advance notification period will begin when a mpleted NOT, including required fees, is received by SRCAA. /
A ( R e c e i v e d T i m e v Au;. 14.4008d 2: 54 PNbt o, 5294endmcnts must be available for inspection at all times at the job site. riot 7/07P r`-"
From:Debbie
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SRCAA NOI No,
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Agency Use Only
SPOKANE REGIONAL CLEAN AIR AGENCY (SR.C.
1101 West College, Suite 403, Spokane, WA
NOTICE OF INTENT (NO!)
For Asbestos Projects and Demolition Projects ,
A. Project Type:
1. ❑ Asbestos Removal
2. ❑ Asbestos Removal & Demolition
3. ED Demolition, No Asbestos Removal r
B. Property
Owner: Dave Scyfert
Job 11049
Phone: 998 -8258
(if available)
Fax: 928 -3933
Property Owner's
Mailing Address: 514 S Arc
City, , Greenacres
State: Wa
; 99016
C. Site
Address: 504 S Arc
City: Greenacres
State: Wa
Zip: 99016
Responsible Site
Contact Person: Dave Seyfert -
Job Site
Phone: 998 -825$
D. j] Asbestos Survey or
• Material Presumed
If survey performed, was asbestos found?
►S Yes • if "No" for any structure, attach survey
Date Survey
Conducted: 7.13.08
No, of Structures: 1
(see back If tl
AWWERA Building
Inspector Name: Dave Seyfert
Certification
Number: 1028269
Exp.
Date: 3 -12 -09
E. Asbestos Project
Information:
I No. of Structures' + Start -��
(see back If >1) l Date:
Completion
Date:
Wk. Days: Su M T W Th i Se
Hours:
Total quantity
to be ternovetlt
Ln,
Feet
Sq.
Feet
Will all asbestos material be 0 Yes
removed by project completion? rl No
Will work schedule
fax pgrp, be used?
U Yes
1 No
,
List individual type and quantity of materials to
be removed or provide an attachment of same:
Abatement
Contractor: IRS Environmental of WA, Inc.
Phone: 927 -7867
Fax: 928 -3933
Mailing
Address: PO Box 152J6
City; Spokane Valley
State; _--WA
Zip: 99215
F. Demolition
Information:
No. of Structures:
(see back if> 1) 1 j
Start
Date: 8/19/08
■ Training Fire (List Plre Dept. a4 demo- contractor below)
[E Ordered Demolition (attach copy of Order)
Demolition
Contractor: Larson's Demolition
Phone: 535 -7944
Fax: 535 -8087
Mailing
Address: PO aox 4535
City; Spokane
State: Wa
Zip: 99202
G, Asbestos/Demolition Project Categories:
Noti icat'on
Wailing Period
Non - Refundable
Project Fee
Does this •ro ect involve a fire -darns ' ed structure? • Yes Et No
1
• Owner- Occupied, Single - Family Residence Asbestos & Demolition Project
►P Owner- Occupied, Single-Family Residence Demolition Project *
Prior Notice
10 Days
$30 —
$250
2.
■ All Other Demolitions With No Asbestos Removal Project
3,
• 10 - 259 linear feet or 48 - 159 square feet (see back of form for options)
3 Days
$250
4.
5.
• 260 - 999 linear feet or 160 -, 4,999 square feet
10 Days
-
$500
$1.25_____n 0
• > 1,000 linear {set or > 51000 liquors feet
10 Days
6._.0. EmergenCV Aebeel'os/Dernolition Project (attach "owner's letter ")
Prior Notice
Twice Project Fee
7.1:1 Alternate Means of Compliance for Friable Materials attach plan)
10 Days
10 Days _
Concurrent with Project
Twice Protect Foe
Twice Project Fee
Regular Project Fee
Twice project Fee
S. ❑_ Alternate Means of Compliance for Nonfriahle Materials (attach plant
9. lill Exception for hazardous Conditions [attach plan)
10. ■ Demolition with Nonfriable Rooftn • Loft in Place
10 Da s
* The two categories in G.1 apply only to owner - occupied, single- family residences, which means any non- multiple unit bui ding containing Jiving
space that is currently occupied (prior to and niter renovation /demolition) by one family who owns the property as their domicile. One of the
categorl4a Must be used for all other asbestos /demolition projects. For more information, contact SRCAA at (509) 477 -4727,
U. Optional: 1.4n uulditional parties you would like copies or this NO1 and%or related notices sent to (list name & fax number and /or mailing address):
Larson's Demolition 535 -8087
T. 1 certify that the
my k-nowiedgo
',a It 4 . i1
information contained in this notification and any supplemental data provided is, to the best of
ace rate and omplete.
al t i1� A . . t,At1 IRS Environrn mtidQJWA. Inc, !�
I
C rrtplcteness R.eview
O>< complete
lL1 NOI deficient -
See Attached
Srgnarure RepreTenring !Jd
Por demolition projects, this ND! expires 12 months ftotn the earliest listed asbestos /demolition project start date,
/1 l j i
:•hy Use 0 ,
Your advance notification period will begin when a mpleted NOT, including required fees, is received by SRCAA. /
A ( R e c e i v e d T i m e v Au;. 14.4008d 2: 54 PNbt o, 5294endmcnts must be available for inspection at all times at the job site. riot 7/07P r`-"
07/14/2008 12:41 5093241567 SRHD EHS
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JIM OR .JACK WIRT€ -H
8.4.03.- TSCHIRLEY RD. - 926.1140
GRE NACRES, Wk. 99016
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RECEIVED 08120/2008 11:37 50968= 001:=7 SV PERMIT CENTERFR
Aug 20 2008 11:37AM SPOKANE #COUNTY #UTILITIES 4777178 p.l
08/2012008 08:07 5096000037 SV PERMIT CENTERFR t'A(±. 01/04
11703E Sprague Ave Suite B -3 4 Spokane Valley WA 99206
• 509.688.0036 1 Fax: 509.688.0037
Transmittal
SPOKANE COUNTY UTILITIES
Fax: 509 -477 -4715
GI- 12,1v ee"S
CSV PERMIT CENTER
Re: ReviewlApproval of Demolition Permit Application
Attn: Billy Urhausen
X Roger Rivers
-..evitn-eretivit
Colin Depner
7.
SITE ADDRESS: SO4 S ARC
,.b r, v'} LA/tort-I< r''
PERMIT PURPOSE: DEMOLITION OF MOBILE HOME AND OUT BLDG
5(3 1 50‘ � . c i s n o + 11 C M 1' MG r1 1 yy Co rt rt GCS e.1 k d +1"e- 5'P' riL"
Ca tA.1 5,aw Gr Sts *em 'check- s er ka.l vo l
v 6fte- s.e L - < - 2 i r+< 20424. A se w L r
Gi,6anaonrr C .?e. ell ► b h ' YGC.i„u►►PC, .
5/z olog
Project Number: 08003254 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 8/20/2008 Page 1 of 2
Project Information:
Permit Use: DEMOLITION OF MOBILE HOME AND OUT
BUILDINGS
Setbacks: Front
Site Information:
Plat Key: Name: APPLE VALLEY EST 2ND ADD
Left: Right: Rear:
Contact: LARSON'S DEMOLITION
Address: PO BOX 4535
C - S - Z: SPOKANE, WA 99202
Phone: (509) 535 -7944
Group Name:
Project Name: NOI - #08 -0270
District: East
Parcel Number: 55192.1910
SiteAddress: 504 S ARC CT
Location:: CSV
Block:
Lot:
Owner: Name: SSEYFERT, DAVID
Address: 514 S ARC CT
SPOKANE VALLEY WA 99016
Zoning: MF -1 MF MDR District
Water District: 134 CONSOLIDATED ID #19
Area: 9,600 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review
Sewer Review
Permits:
Released By:
NOT CONNECTED TO SEWER PER ROGER RIVERS @ CTY UTILITIES.
Originally Released: 8/20/2008 By: JLMain
Demolition Permit
Contractor: LARSON'S DEMOLITION INC Firm: LARSON'S DEMOLITION INC
Address: PO BOX 4535 Phone: (509) 535 -7944
SPOKANE WA 99220
Item Description
DEMOLITION - RESIDENTIAL
DEMOLITION ACCESSORY
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
Fee Amount
$44.00
$20.00
Permit Total Fees: $64.00
Operator: jmm Printed By: jmm Print Date: 8/20/2008
Project Number: 08003254
Notes:
Inv: I
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 8/20/2008
Payment Summary:
Permit Type
Demolition Permit
Fee Amount Invoice Amount Amount Paid Amount Owing
$64.00 $64.00 $0.00 $64.00
$64.00 $64.00 $0.00 $64.00
Page 2 of 2
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and /or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: jmm Printed By: jmm
Print Date: 8/20/2008