2012, 04-12 Permit App: BLD-2012-0371 Demo, Remove GarageoPokane
.•••*Valley -
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
perm itcenterPsooka neva l lev.orq
(Staff UseOnly?
PERMIT NUMBER: '�/ ` — l Z 31 1
PERMIT FEE: 2 L e779/
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: 12409 E. Boone Ave
ASSESSORS PARCEL NO.: 45152-0907
BUILDING OWNER NAME: Spokane Valley Hospital & Medical Center
MAILING ADDRESS:* 12606 E. Mission
Cm: Spokane Valley STATE: WA ZIP: 99216
CONTACT PERSON NAME:
Greg Palmanteer
PHONE: 509'173-5369 FAx: 509 473-5738 CELL:
CONTRACTOR NAME: Larson' s Demolition, Inc
MAILING ADDRESS: PO Box 4535
Cm: Spokane STATE: WA ZIP: 99220
PHONE: 509 535-7944 FAX: 509 535-8087 CELL: 509 994-3995
CONTRACTOR LICENSE No.: L AR S OD I 1 6 4 R U EXPIRES: 12/31/13 CITY BUSINESS LICENSE NO.: 600556997
PROJECT DESCRIPTION (Please Provide Site Sketch)
El Site Plan Provided ❑ Notice of Intent # 12-0016
El Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
Demolition and Removal Residential Garage
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 . ny violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be requjcpd to be submitted and su uentiy approved before this application can be processed.
Signature
Method of payment: 0 Cash
Bankcard #:
❑ Check
Date: 4/12/2012
['Visa 0 Mastercard
EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\Forms\Building forms\Demolition Permit App.1.doc
•
e 1.M) damollllonjee Is waived f demolitien Isp1sformedln conjunction wlth asbestosproject category 3, 4 or S, above.
9.dditional Categmies WhcbMayAppytotheProjeot iul-6Above
Liner,enc. )
7.0 Emergency
Reit NN lulu; 1
Section 9.04.A.&h Prior Notice
Twice the Regular Fee
Select the reason that best describes Your situation:
0 Sudden, unexpected event that resulted in a Public health or safety hazard.
0 The project must proceed immediately to proiect equipment, ensure continuous vital utilides, or min' imize property damage.
0 Asbestos-containieg materials were encountered that were not identified during -the asbestos survey.
• The project must proceed to avoid imposing an unreasonable financial burden.
Altermite .A.shetos NVoi-1‘ PrActice:,
Reference Period Non-RefiHni2id1'Lc
loicane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / www.wokanecleanair.org/ Ph:(509)477-4727 Fax: (509) 477-6828 09/09
.
Lg li V g
APR 0 4 2012 -
SPOKANE REGIONAL
ceiriften-AfeetrerradY
Notice of Intemt No.
use 0
() FR li_ (ri: 1 Vi.ENT
Spokane
1 ul: \ •10 Ld 4)• 1'11)11 4 lo.
', 111 \14)1 1 j H
Clean14.40n4AirRefer
to e cy's Renovation, Demolition, and Asbest�s in orniatioil Sheet as weli as Regulation I, Article IX
A. Project Type:
0 Asbestos Removal
0 Asbestos Reinoval& Demolition
1---, .v. •
L1 x.Demolition, No Asbestos Removal
Does this project involve a •
0 Yes 151No
1fyes, refer to Sections 9.03.F3 and 9.08)
Does this project involve demolition by fire '
XYes - No
(See Sections 9.02.R, 9.03.FA & 9.044.6.f)
How many contiguous structures does this proj olve? (5 '
max):
. 2
(If More than 1St= . .oil 9.04.A.3)
B. Property Owner:
Valley Hospital & Medical Center
12606 E. Mission ,.
Phone:
city:
509 473-5469
Spokane Vali
Fax:
.
Wk I
Zip: 921 6
Mailing Address:
C. SiteAddress:
12409 E. Boone '
_ C:pP0kanSVau1ettey
.
zap: 1)921 6
Contact Person:
Jeff f La.rson 1
Job Site Phone:509 994-399
D. Q Asbestos Survey 'a
0 Materiel Presumed
Date survey performed:f 9/ 05/ 2011 fHERA Bldg. Inspector Neater
/?titi 13erg
Was asbestos
found?
10 Y No
'
Company:
AAA Constructiairt.
Incorporated
No.:
IIIR-10-0B6
E. Asbestos Removal
Information:
Start
Date:
3/05/2°12
Comp o
Date:
3/05/2°1
Abatement By
f known):
•
List individual Ine and
quandty of materials to be
2 szjaare ft. rIg M•vinsim biit0.-
removed. If >1 structure, list
materials for each structure,
by address / location.
"
Total Linear Feet: _
Total Square Feet 1
2
win all asbestos naexia1 be removed from the-structure4) by project completion?
9
Yes
0
No
F. Demolftion
Information:
Start
Date:
(earliest)
4/16/2012
Demolition By
of.known):
lareznt s Daroli ' .
G. Asbestos Project and Demolition Notification W4ting Perlod and Non -Refundable Fee Categories
Your advance notification period will bcglnwhen acornplete4NOi, inc1udingrequfredonrefimdab1e fees,is received by SRCAA.
(,)),, Ilk 1-11 1111111 (i, sIl"il 1:111)11:1 i e'•ith lh e ( `2. (f.' ReliON a t/011, [kill°, IN.. ‘sbI.1),, inio. ,littt)
.
. . 1. 0 10 In ft and/or 2 48 sq ft asbestos o g -owner
11,111.111u Pt 1 [oil
PrlorNotice
1 i t
2.0 All Demolition (ell asbestos must be poper1y emoved and disposed of prior to dem ' )
Nkll oN)Illl Ot C11 t ri, ,i14t?,1e-laiiiily residence
3.0 10-259 In ft and/or 48-159 sq ft asbestos3
3 Days
NI.ii•tiii2 erind
Days
$30
=50
4.0 260-999 In ftand/or 160-4,999 sq ft asbestos •10
Days
8500
5. 0 a 1,0001n ft and/or 2 5,000 sq ft asbestos
10 Days
$1,250
6. ED All Demolition
— -- - - - -- - - - - - - - -
10 Days
$250*
e 1.M) damollllonjee Is waived f demolitien Isp1sformedln conjunction wlth asbestosproject category 3, 4 or S, above.
9.dditional Categmies WhcbMayAppytotheProjeot iul-6Above
Liner,enc. )
7.0 Emergency
Reit NN lulu; 1
Section 9.04.A.&h Prior Notice
Twice the Regular Fee
Select the reason that best describes Your situation:
0 Sudden, unexpected event that resulted in a Public health or safety hazard.
0 The project must proceed immediately to proiect equipment, ensure continuous vital utilides, or min' imize property damage.
0 Asbestos-containieg materials were encountered that were not identified during -the asbestos survey.
• The project must proceed to avoid imposing an unreasonable financial burden.
Altermite .A.shetos NVoi-1‘ PrActice:,
Reference Period Non-RefiHni2id1'Lc
loicane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / www.wokanecleanair.org/ Ph:(509)477-4727 Fax: (509) 477-6828 09/09
! OK4NE COUNTY UTILITIEEtoA1 TMENT
c01OE (0EWE12 CONNECTION
1 N OIOECT1ON t2EfOO12T CAS P)ON17: VW" 0 NO tI
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VLMI'J1v1y1U1.1 1.1.6.).AS ;A0tOrrIot i : PIN,ES 20 8501 w,- ;P)L.00K N2•: 15547 -O,o7
TYPE¢ 4.01ZE OF PIPS : 411P.v,c,
utr.PEt22Mt-r. No.: 2,(D /88
ALS EXG IN6,P r06TE : S. 1 I' 88
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N. pines
Garage
NOT TO SCALE
House
12409 z. Boone Ave
BOONE AVE
S