2013, 03-28 Permit App: BLD-2013-0526 Demolish BarnSpokane
do•OValley
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@sooka nevalley.orq
(Staff UseOnly) %
PERMIT NUMBER: L/ [ r'
PERMIT FEE: Z- 1 C'4' y
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS:
/ 8 7d 7 / ' /'he__ l
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME:
S i EV lei 13/9AT: S
MAILING ADDRESS:
CITY:
STATE:
ZIP: 7(?(9
CONTACT PERSON NAME:
/ TV/z 1j i L
PHONE: 50 a j0 - •6, FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE:
ZIP:
PHONE: FAX:
CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
❑ Site Plan Provided ❑ Notice of Intent #
0 Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
A/ AUS (— (AJnOrp
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 -iibrpitted aqd su ently, proved before this application can be processed.
Signature
Date: --
Project t
RECEIVED
MAR 2 8 2013
CSV PERMIT CENTER
SUB #
REV.
I�v.
Updated 1-11-11 Page 1 of 1
http://www.spokaneval ley.org/filestorage/ 124/938/210/948/1496/Demolition_Permit_1-11-11.doc
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Notice of Intent No. Spokane ' f4,
FOR ASBESTOS PROJECTS / DEMOLITION
Agency Use Only Catiiat At4
SPOKANE REGIONAL
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Waiting Period Fee
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2. PC All Demolition
Not owner -occupied,
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(all asbestos must be iroperly removed and disposed
single-family residence
ft and/or 48-159 sq ft asbestos (also for <10 In ft or <48 sq
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Number of 1,000
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= $ + $1,250 base fee =
Number of 10,000
sq ft increments beginning at 10,000 sq ft:
x $250 =
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6. 0 All Demolition
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Page I of 2
SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828
3/11
SCIMAP
55181.30040
55181.3004
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18309
55181.3056
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55181.3211
55181.3204
55181.3210
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