2006, 09-29 Permit App: 06003907 Demo HousesSpot ane �°'
coostOalley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www. spokanevalley.ore
PERMIT NUMBER: 3 9d 0
PERMIT FEE:
D b
Demolition Notice of Intent Commercial
Permit Application # nta 474 \ n Residential
SITE ADDRESS:
7((8 E
ASSESSORS PARCEL NO:
Building Owner- _
�arT WA4OFh4r4P
.Contractor:
- RoA S OEM6L T (P M
Name: 7it. (S. fr4A-eh'(tt 4a /z_
Name: n
R o R @,4RPFR-
Address: rrs r C e Aoa KF
Address: 20 E Waco e41&paRI< nart'F
/
City: $»,z 4 (vE fIiLCtt3 WA. ff (-1b
City: -3 p (4li-NOE State: w Zip:79 l7
Pone: Fax: /
<'Gle: 9216123
Phone: Fax:
So9-7z8_oy�( SD� say 9Ya9
JI
Contractor Lic No: g. 083 pp Exp Date: /
Contact Person
23 diOt)
City Business Lic. No:
Name: WfAte eNAA R•
-
Phone: sm, g o z 6 t/ 2_3
Describe the scope of work in detail****NOTICE OF INTENT REQUIRED****
RFtin oxc botL l.ouye5, deRxe5'
Cost of project: $ g-. 2 r • O 0
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) This 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 submitted, and subsequently approved before this application can be
processed.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signature
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
Date
REVISED 823.2005
Your advance notification period will begin when a completed NOI, including required fees, is received by SCAPCA.
A copy of the asbestos survey, completed notification & all amendments must be available for inspection at all times at the job site. NOI 8/06
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SCAPCA NOI No.
//
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`v `Agency Use Ono,
SPOKANE COUNTY AIR POLLUTION CONTROL AUTHORITY
1101 West College, Suite 403, Spokane, WA 99201
NOTICE OF INTENT
(NOI) TO PERFORM:
DAt__
U
vat
a .
S n UsE 6
A. Project Type:
1. U Asbestos Removal
2. U Asbestos Removal & Demolition
3. U Demob Lrn0 t ; 4pbestos, itt.pcn9, j I
B. Property,MINOONTROL
Owner: ici 9' •• W(H.t.'Y .Ty,f_JA 6.1EN AA PC
Phone: scy;-.oil (371
AITTHOF
Fax:.
Property Owner's E n
Mailing Address: j j C/C /2.Cr,'(yF
City:?hr:ietihi: i'iJ�G`v
State/a
Zip:Og?r2/
C. Site 4 /;iV
Address: 1' 7 / / (;_:1,,,,,:x..., ' S L %
City: ?g /4M, (5(3GLF!-State:
Zip: V c c f `_
Responsible Site ! / Job Sitet '
Contact Person: /1 i; (4 ttArs v../.14-b- C r )1• ')-A- 7 Phone: i C y ! V U ci 7
D. I Asbestos Survey or
❑ Material Presumed
If surveyuerformed, was asbestos found?
0 Yes ❑ If No, Attach Survey
Date Survey 6, ._ -1 -2 No. of Structures:
Conducted: (see back if>1)
AHERA Buildingr.,
Ins rectorName: TJ ` 411 1"`C L.1 Li'L
Certification
Number: 113 (I -G fi -- V T7
Exp. c' „
Date:
E. Asbestos Project
Information:
No. of Structures:
(see back if>1)
Start
Date:
Completion
Date:
Wk. Days: Su M T W Th F Sa
Hours:
Total quantity
to be removed:
Ln. ( Sq.
Feet I Feet
Will all asbestos material be U Yes
removed by project completion? 0 No
Will work schedule U Yes
fax pgm. be used? . 0 No
List individual type and quantity of materials to
be removed or provide an attachment of same:
Abatement
Contractor:
Phone:
Fax:
Mailing
Address:
City:
State:
I Zip:
F. Demolition
Information:
No. of Structures:
(see back if> 1) Z
StartU
Date: I v 1 Zl d 6
Training Fire (List Fire Dept. as demo. contractor
below)
0 Ordered Demolition (attach copy of Order)
Demolition �i tel
Contractor: A 6 !b ' - [� L' t "1 0 L 1 77 O T -
o� r% j Ck
Phone: 5-o?y 9Z S-cY I
Fax: fog -5- 9 Y cr C'4/
�r
AddresMailins: c7 `I fG C(},S'� VV?Cp cr. (i/4/Zit 1 aiver.
City: pc't.e.NF
State t/ 4
Zip79 2 t 7
G. Asbestos/Demolition Project Categories:t�-�
Does this project involve a fire-damaged structure? 0 Yes ICJ No
Notification
Waiting Period
Non-Refundable
Project Fee
1. U Owner-Occupied Residential Asbestos Removal & Demolition Project *
LOwner-Occupied Residential Demolition Project Only *
prior Notice
$30
2. U All Other Demolitions With No Asbestos Removal Project
10 Days .
$250
3. U 10 - 259 linear feet or 48 - 159 square feet (see back of form for options)
3 Days
$250
4. U 260 - 999 linear feet or 160 - 4,999 square feet
10 Days
5500
5. U > 1,000 linear feet or> 5,000 s r - feet -
10 Days
$1,250
6. U Emergency Asbestos Project or U Emergency Demolition Project
Prior Notice
Twice Project Fee
7. 0 Altemate Means of Compliance for Friable Materials or U Demolition
10 Days
Twice Project Fee
8. 0 Altemate Means of Compliance for Nonfriable Asbestos Materials
10 Days
Twice Project Fee
9. U Exception for Hazardous Conditions
Concurrent with Project
Regular Project Fee
• The two categories in G.I apply only to owner-occupied, single -family residences, which means any non-multiple unit building containing living
space that is currently occupied (prior to and after renovalion/demolition) by one farm y who owns the property as their domicile. One of the
categories in G.2-9 must be used for all other renovation/demolition projects. For more information, contact SCAPCA at (509) 477-4727.
H. Optional: List additional parties you would like copies of this NO1 and/or related notices sent to (list name & fax number and/or mailing address):
L I certify that the information contained in this notification and any supplemental data provided is, to the best
of my knowledge, accurate and complete.
4 i 6 - E 1
empleteness Review
NOI complete
0 NOI deficient -
eeAtt, pet
e.,_
V / Date 1
Signature / Representing
. gency Use •nty..
Your advance notification period will begin when a completed NOI, including required fees, is received by SCAPCA.
A copy of the asbestos survey, completed notification & all amendments must be available for inspection at all times at the job site. NOI 8/06
TY