2010, 10-18 Permit App: 10003429 Demo MHSpokane
jValley�
PROJECT ADDRESS:
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenteresooka nevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
Lk
DEMOLITION PERMIT APPLICATION
ASSESSORS PARCEL NO.:
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BUILDING OWNER NAME: I C(nenx5a ' '" 1 L tc/J 1/J
MAILING ADDRESS: / F9/ C a- /�/ao/ ✓(ie -
Cm: xr//U/Irl
CONTACT PERSON NAME: / / ) nS �/ W l /
PHONE: 5-07 jc FAX:
STATE: VL'iT�
MI) y
ZIP:
CELL:
CONTRACTOR NAME:
VI) /) ~y ` •-,.j '(C
MAILING ADDRESS:
CITU:
STATE: ZIP:
PHONE:
FAX:
CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
LSitalar'1Pr- iyided� [_Notice of Intent -#m
CI Spokane County Utilities has approved the disconnection do sP / Fi C
Describe the scope of work in detail /
Des/VIA-CA d-- � rv�ov� / 96� ✓1q4 L' %ra( /7)/
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) Own4rship 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 vio tion of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be sub ed an• - bsequen approved before this application can be processed
Signature
Method of payment: ❑ Cash
Bankcard #:
heck
cAe l7 Date: /61 ( ?/?.2/y
❑Visa ❑ Mastercard
EXP: VIN#:
Authorized Signature:
Effective October 28, 2007
P:\Community Development\Forms\Building forms\Demolition Permit App.1.doc
Page 1 of 1
RECEIVED 10/18/2010 15:55 5096880037
10/18/2010 15:51 5099283933
Spokane Regional Clean Air Agency - Print NO1
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Print NOT
Back
Customer Information
Company:
Owner:
Contact:
Email:
Phone:
Address:
Licensed Asbestos
Abatement Contractor:
Demolition Contractor:
Property Owner:
Other:
NOT Information
IDNUM:
Project Type:
Additional Info:
Fee:
Property Owner:
Site Address 1:
Site Contact:
Multiple Structures:
Asbestos Survey:
Material Presumed:
MRS Environmental 01 WA, Inc.
IRS Environmental WA, Inc.
Rob Reed
sash{n'.irsenviro.cam
509-927-7867
PO Box 15216
Spokane Valley, WA 99215
YES
NO
NO
IRS ENVIRONMENTAL
• 2010-0347
SV PERMIT CENTERFR
PAGE 01/02
Page 1 01'2
Owner -occupied, single-family residence - all demolition
$30.00 (PAID)
Bud Selby
509-216-7064
18917 E Bloom Circle
Greenacres, WA 99016
18917 E Bloom Circle Rd
GreenaCres
Amos Hunter
509-475-6300
YES
NO
r - r .•... ,.. nrrt/print nn; acn9icd=594&template=false
10/15/2010
RECEIVED 10/18/2010 15:55 5096880037
10/18/2010 15:51 5099283933 IRS ENVIRONMENTAL
Spokane Regional Clean Air Agency - Print NOT
Asbestos Found: YES
Survey Date: 10/14/2010
Inspector: Jeff Robinson
IRS Environmental
#107842
Project Dates:
Structure
SV PERMIT CENTERFR
PAGE 02/02
I'age2of2
Quantity Type
Removal By:
Removal Completed: NO
Materials:
Contractor:
Demolition Structures: 1
Demolition Date: 10/22/2010
Demolition By: Demolition Contractor
Unknown at this time
Job 4/00000
Unknown
Unknown
Unknown
Unknown, WA 99216
Fire Damage: NO
Emergency:
Alternate:
All asbestos to be removed by project completion: YES
NDI Submit Date: 10/15/2010 3:51:20 PM
ii..„,„,c.n„4a,Frlrannir.nre/vdnt noi.asp?id-59418ctemplate=false 10/15/2010