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2012, 04-12 Permit App: BLD-2012-0369 Demo, Remove ResidenceSirrce'l�llll'�� Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3(- Spokane -3'Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 permitcenter@sooka neva I lev.orq (Staff Use Only) PERMIT NUMBER: R I f' Z — PERMIT FEE: 14 " *C' 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 Cnv: Spokane Valley CONTACT PERSON NAME: STATE: WA ZIP: 99216 Greg Palmanteer PHONE: 509 '473-5369 Fax: 509 473-5738 CELL: CONTRACTOR NAME: Larson' s Demolition, Inc MAILING ADDRESS: PO Box 4535 CITY: Spokane PHONE: 509 535-7944 CONTRACTOR LICENSE No.: LARSODI1 64RU STATE: W A ZIP: 99220 FAX: 509 535-8087 CELL: 509 994-3995 EXPIRES: 12/31/13 CITY BUSINESS LICENSE No.: 600556997 PROJECT DESCRIPTION (Please Provide Site Sketch) Site Plan Provided ❑ Notice of Intent # Spokane County Utilities has approved the disconnection Describe the scope of work in detail Demolition and Removal Residential House 12-0016 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 requJd to be submitted and sine uently approved before this application can be processed. Signature Date: 4/12/2012 Method of payment: D Cash 0 Check ['Visa ❑ Mastercard Bankcard #: EXP: VIN#: Authorized Signature: Effective October 28, 2007 P:\Community Development\Forms\Building forms\Demolition Permit App.l.doc Page 1 of 1 ("c—d0 L� Notice oflritentNo. gency Use Only Spokane Clean Air NO1 I ;E (F TNS FOR ASliESl OS PRO.IFt 15 /1/E EN ol.rrroN F( -Fly �...._ , . • APR 04 2012 - SPOKANE REGIO A Ditly Refer to the Al ency's Renovation D, eemmaL'}ion, and Asb as Lifo Sheet as well' as Regulation *de Project Type: Asbestos Removal bestos Removal molition Demolition, No Asbestos Does this project involve a fire -damaged Does this project involve demolitioa'by fire tra ow many contiguous stmctures does this. of max): re ❑ Yes [ No ifyes, to Sections 9.03.F3 and . 08) involve? ( Y See Sections, 9.02.8; 9 03.FA & 9.O4...6 More thsttii strnctuie, refer to Section 9.04.A3) B. Property Owner. Valley Hoepital & Medical Center Mailing Address: 12606 E. Mission 1. Phone: City: 509 473=5469 Spokane Mali Fax: 91tate: • • Address: 12409 E. Boone Chu: Spokane-Af 1eY Contact Person: Jeff Larson WA Zip: 1921 WA Zip: Job Site Ph 92 6 .509 994-399 Asbestos Survey f 0 Material Presumed Date survey perfonned:I 9/ 05/ 2011 IAHE ldg. Inspector Name: P 1 Berg Was alb found? tos Yes ❑.No: Coriipany AAA- Constructs, No.: Incorporated AIR -10-086 K1R11-164 E. Asbestos Removal Information:, Start Date: 3/05/.2.. Comply Date: On 3/05/2012 Abatement By (if known): W Ctris-triactian 11-rxrparated List Individual tpg and quantity of materials to be removed. If>1 structure, list materials for each structure by address / location. 2 .e ft. 71 F Total LinearFee : Will all sal beremoved from,the- F. Demolition Information: Start Date: (earliest) G. Asbestos Project and Demo Your advance notification Owner occupied, single-familyresidt:nce (•e 2 Notification 1. ❑ Z 101n ft add/or 2 48 sq ft esbes los pry 2. ❑ All Demolition (all asbestos mus be p. Demolition By (if known): Total Square Feet 1 2 eture(s) by project completion? © Yes 0 No Larson's Darolitkn, Inc. Wa ting Period and Non -Refundable Fee Categories c a d NOI, including required nonrefundable fees, is r lie Ren? vatiou, Demo., c� >o Asbestos info. sheet) )Waiting Period ig=owner . PriarNotice SR Fee 0 Not owner -occupied, single-family residence 3. L, j 40-259 In ft and/or 48-159 sq ft asbestos 4. ❑ 260-999 In ft and/or 160-4,999 sci It asbestos 5. ❑ >_ 1,000 In ft and/or 2 5,000 sq ft asbestos moved and disposed ofprior to demo 3 Days $30 Waiting Period Fee 3 Days 5250 lO Days • 5500 10 Days $1,250 6. l Demolition . * The $250 demolition fee is waived ff'demolition is p Mona). Categories Which May Apply to f1 Project Emergency Notification ergency Select the reason that best describes your situati+n: ❑ Sudden, unexpected event thatresolted in a public health or safety hazard. ❑ The project must proceed immediately to protect equipment, ensure continuous vital utilities, or minimize property damage. ❑ Asbestos -containing materials were encount+ed that were not identified during the asbestos survey. ❑ The project must proceed to avoid imposingan unreasonable financial burden. • - 10 Days '$250* informed in conjunction with asbestos project category 3, 4 or 5, above. - ories in 1-6, Above Alternate Asbestos Project Work Practices Ave:, SpoIcane, WA 99207 / wwwsuokanecleanair.ore / Ph:(509)477-4727 Fax: (509) 477-6828 09/09 Reference Waiting Period Von -Refundable Fee ire Clean Air, 3104 E. An •I' SS -o1 —on of *OK4NE COUNTY UTILITIES tJEt° J2TMENT I I DE t'JEVIEf2 CON NECTI VN 1 N OtO TION a moot T A*012..E, : .124oV 13ooNia AVE , CO f rUt2 VUPbr'JIVicoION NAME; ; AVIOMOt4 : PANES 20- 85th OtoEt2ATd12/114i,to9Crot2 t 1LLt AL 5 EX.G u.V.PEJ2MLT Ns : 12`D/8e CAW P) )P4? : Yee" Cl No ItJ5t0.TD TE :5• 11'88 LOT is PbLOCK Na.: 15547 -o,07 TYPs+ y12a OF PIPE : 4"P.v,c. ATE rzacwszKeo Fvr2 CA.CW PO)4 r2RLE.& E : COM M at4Te0 : PTf C, jz;u MPEo 4 Ft l.Le r:,). IMINIIIMmahmv !21 CTP1214L YJIc c12AM Garage NOT TO SCALE House 12409 P . Boone Ave 13OONE AVE S