2004, 09-23 Permit App: BLD-04-07751 Demolish ResidenceSep 23 04 01:13p
Spokan`e�`4
4# J
Larsons Demol ition, Inc
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509 535 8087 p.2
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone; (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS. 214 N. Slake
ASSESSOR'S TAX PARCEL NUMSER(5)•
LEGAL DISCRIPTION:
PERMIT DESCRIPTION-: I* ia1 Hzuse Dacolitirn
Q$u]AINNG PERMIT - a CHANCE MUSE • QBRABING f MANDP4 CTURED ROME
DREEOCAIION COIGN DTENANtT QOTITER -
OWNER / APPLICANT INFORMATION
• OWNER: - Jadc I§Tll]n
O APPUCANTC Larson' s Dataliticn, Irc.
PHONE: 509 926-4724 FAX: PHONE: 509 535-7944 . FAX: 509 535-8087
ADDRESS: 914 oc Riako SithETIe Valley, 4a - - ADDRESS P.O. Rx 4;15 S,xdee IAA 99220
CITY,STATE, ZIP • CITY, STATE, ZIP
® CONTRACTOR: SaIE as Acplicant Q ARCHITECT'
PHONE FAX: PHONE: FAX
•
ADDRESS: - ADDRESS'
CITY,. STATE, ZIP CITY, STATE. ZIP
WA ST CONTRACTOR LICENSE Ti IAREI l641U CONTACT: 7fFF Iar'971
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 030
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:. 2" FLOOR SQ FT -
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT.
NUMBER OF STORIES: 1 STRUCTURES ON PROPERTY:_2_ FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS' GARAGE:
ATE: .��,,•�� 'STAFF:.
METIfidD OFPAYA/ENT.
0 0 0
CASH CHECK
BANIWARD egle
SEP 23 2004 14.27
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VISA
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509 535 8087 PAGE.02
Sep 23 04 01:14p
Larsons Deniolitio; Inc`
509 535 8087
p.3
I SCAPCA NOI No.
Use o h
SPOKANE COUNTY MR POLLUTION CONTROL AUTHORITY
1101 Wan College, Sidle 403Spokane, . WA 99201
NOTICE OF INTENT
(NO1) TO PERFORM:
Date Received
Agency tike Ony-
IA. Project Type: 11. ❑ Asbestos Removal (2. U Asbestos Removal & Demolition' 3.1.4 Demolition, No Asbestos Removal
B Property
Jade n
H3lt
Owli
Owner:
Ow
Phone: 509' 925-4724
Property Owner's
Mailing Address: 214 N. Blake
City ark -Am 37ai lcv
State: um
Zip: gg71m
C Site
Address: 214 N. Blake
Responsible Site
Contact Person: Jeff Iazsr
City a teapot
State: reA I
Job Site
Phone: 994_3995
Zip: 91716
D. 14 Asbestos Survey or
❑ Mat'I Presumed:
If surveyormed, was asbestos found?
U Yes 13 If No, Attach Survey
Date Survey
Conducted:9/03/04
AHERA Building
Inspector Name: Jamb Famc3s
Certification
Number. Ur -04--004
No. of Structures:
(see back if> 1) 1
I( Exp.
Datc: 4/29/05
E. Asbestos Project
Information:
No. of Structures:
(see bad(
Total quantity
to be removed:
if> 1
Linear
Feet
Start
Date:
Square
Fest
Completion
Date
Will all asbestos material be U Yes
removed by project completion? 0 No
Insured
on CInFa
Pipe utation ❑ epnw6ng
and ❑ floonng Mat9 0 FriabteRoofmg
Type of material
to be removed:
❑ 8oileeiFumate ins
❑ Textured Coatings
U Duct lnsu
❑ Cement Bo
Wk. Days: Su MTWThFSa
Hours:
WiU work schedule U Yes
fax to. be used? El NO
LI taints 0 Plaster
0 Other
Abatement
Contractor.
Phone:
Fax:
Mailing
Address:
City:
State:
Zip:
F. Demolition
Information:
No. of Structures:
(see backif> I) 1
Start
Date: 9/27/04
❑ Training Fire (List Fire Dept as demo. contractor below)
❑ Ordered Demolition (attach copy of Order)
Demolition
Contractor Tarsn's D3to itirn. Inc.
Phone: 509 518-7944
Fax:
509 535-80137
Mailing
Address:
P.O. Rx 4535
City: ariwe
State: V
Zip: 99220
G. Asbestos/Demolition Project Categories:
Notification
Waiting Period
Non -Refundable
Project Fee
1. ❑ Owner -Occupied Residesttiai Asbestos Removal & Demolition Project a
SI Owner -Occupied Residential Demolition Project Only
Prior Notice
2. ❑ All Other Demolitions With No Asbestos Removal Project
10 Days
3. U 10 -259 linear fed or 48 -159 square fed (see back of form for options)
3 Days
4. ❑ 260 - 999 linear fed or 160 - 4,999 sgua a feet
10 Days
5. ❑ 1.000 - 9,999 linear fed or 5,000 - 49 999 square fed
10 Days
6. ❑ > 10,000 linear feet or> 50,000 Nutt feet
7. ❑ Emergency Asbestos Project or 0 Emergency Demolition Project
10 Days
Prior Notice
8. ❑ Attanate Means of Compliance for Friable Materials -or LE Demolitions
10 -Day Review Period
9. ❑ Alternate Means of Compliance for Nonfriable Asbestos Materials
Conamentwith Project
525
5150
5150
5300
5750
$
1,500
Twice Protect Fee
Twice Project Fee
Twice Project Fee
• The two categories in 6.1 apply only to owner -occupied, .single -Family residents, which moms any non -multiple snit building containing living I
space that is currently occupied (prior to and atlet awvalia✓d®alition) by one tamely who owns the pmpaty as their domicile. One of the '
categories in G.2-9 must be used for all other renovation/demolition projects. For mote information. contact SCAPCA at (509) 477-4727.
R. Optimist List additional parties you would 1&e copies alibis NOI and/or related notices scat to (list name & fax numberand/or mailing address):
L I certify that the information contained in this notification and any supplemental data provided is. to the best
of my lmowldge, : • • o : and complete.
rt0[M
Lamm!^. (7!3[r�litirr� Trr
Representing
9173104
Completenesr
Review By:
Agony the Onh'
•
• . ...•. _ J _m, k.i -.�__ _--__•�.�--.:<..-�� .-..L.A:,. ..A r :a •vrj.i .M 171, Cr APrA
** .•anec Has already ]. erest3i the 5331er cn t}'2 electrical 83t
SEP 23 2004 14:28
509 535 8087 PAGE.03