2006, 08-15 Permit App: 06003200 Tear Down BuildingSpokane
galley
Community Development
Permit Center �y+
11707 E Sprague Ave, Suite 96l
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)6$'-0
www.spokanevalley.org. I D
ECEfIVE
AUG 15
37
LUDDD
Demolition Notice of Intent
Permit Application�l # c (o-Oea
SITE ADDRESS : I— 7 ' ( l (y [� o/l
ASSESSORS PARCEL Nc jH
Commercial
Residential
Building Owner
Contractor:
Name: n612A,
Address: /( S/4_. /jo o N f=
Name
Address:(�7 / > — 90 o Xi
City: 97o k A NE -
Phone: 9 2 E C39 9
State: W4 Zip:
Fax:
City: 5'
Phone:
D ket Ne
632 /
State: W
Fax:
Zip:
„20
Contact Person
Name: ,„,r,•r �Cll
Phone: y, Z 6 -cli 7 /t' 1
Describe the scope of work in detail***:MOTIg OF INT NT REQUIRED****
Contractor Lic No: Exp Date:
City Business Lic. No:
Cost of project: $
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 "dee
- Date
Method of Payment:
a Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8232005
SCAPCA NOI No. •
0 %` 9,5.9
Agency se Only
SPOKANE COUNTY AIR POLLUTION CONTROL AUTHORITY
1101 West College, Suite 403, Spokane, WA 99201
1101
OF INTENT
(NOI) TO PERFORM:
ate R cera byTtatItte
AUG 1 4i 2006
Agency Use Only
YAI
A. Project Type:
I. U Asbestos Removal
2. U Asbestos Removal & Demolition
3. 4Iani44• _ 6cimyEe ovaH
B. Property • ci
Owner: .., c/% ��
Phone: ,J �i%'t ' Y / e ?
(If available)
Fax:
Property Owner's�'�
Mailing Address: /7. / 6 t. < /LP -7P
City:, - t/> t/ P,/
States:47 •
Zip: 7fr(.. 46
C. Site 04,4L,/,
Address: `�//� i
lI
City:4 �d%s,'Y�/� ,)
Stater
Zip: �/q l�
Responsible Site ��
Contact Person: ,47 Jz/v JI:1- �./ •
Job Site
Phone: 5—i'r
�C 41
D. U Asbestos Survey or r
❑ Material Presumed
If survey/,p rformed, was asbestos found?
❑ Yes f2] If No, Attach Survey
Date Survey _
Conducted: ,f-7 -e-'L
No. of Structures:
(see back if>
) 1
AHERA Building
Inspector Name: fin iinfr
Certification
s/CG
Exp.
Date: ---26
$'1Number
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.
Feet
Sq.
Feet
Will all asbestos material be U Yes
removed by project completion? ❑ No
Will work schedule ❑ Yes
fax pgm. be used? ❑ 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:
Zip:
F. Demolition
Information:
No. of Structures:
(see back if> 1) ,r
StartU
Date: $ - /3= a
Training Fire (List Fire Dept. as demo. contractor below)
❑ Ordered Demolition (attach copy of Order)
Demolition i /-
Contractor: -2-2/27-z,‘,-;,/
�)J/ -titec,c_.
Phone: 3-0 9 - 76 .`A'Taix:
Mailing/
Address: %��% 5- /_,'t
City:
/4 �///.1
State: L1
ggc
G. Asbestos/Demolition Project Categories:
involve a fire -damaged structure? ❑ Yes ❑ No
Notifi tion
Waiting Period
Non -Refundable
Project Fee
Does this project
1. U Owner -Occupied Residential Asbestos Removal & Demolition Project *
A Owner Residential Demolition Project Only *
Prior Notice
$25
-Occupied
U All Other Demolitions With No Asbestos Removal Project
10 Days
$150
2.
U 10 259 linear feet or 48 - 159 square feet (see back of form for options)
ys
3Days
$150
3. -
0 999 linear feet or 160 - 4,999 square feet
10
$300
4. 260 -
5. Li 1,000 - 9,999 linear feet or 5,000 - 49,999 square feet
10 Days
Days
10 DayayNotsce
$750
5
$10
, 0
1,5 Oct
6. 0 > 10,000 linear feet or > 50,000 s_quare feet
Prior
Twice Fee
7. U Emergency Asbestos Project or Li Emergency Demolition Project10
U Demolition
Days
Twice Project Fee
8. 0 Alternate Means of Compliance for Friable Materials or
10 Days
Project
Twice Project Fee
9. 0 Alternate Means of Compliance for Nonfriable Asbestos Materials
Concurrent10with Project
Regular Fee
10. U Exception for Hazardous Conditions
which
means any non -multiple un t building containing living
* The two categories in G.I apply only to owner -occupied, single-family residences,
space that is currently occupied (prior to and after renovation/demolition) by one fam'Iy 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.
address):
H. Optional: List additional parties you would like copies of this NOI and/or related notices sent to (list name & fax number and/or mailing
Review
I. I certify that the information contained in this notification and any supplemental data provided is, to the best
of my knowledge, accurate and complete.
�/,_/ _ G.,
®NOIteneSs
❑ NOI deficient
e• Att: hed.
i-
r ' ' Air Dale
Signn(ure
W'S
Agency. se Only.
Your advance notification period will begin when a completed NOI, including 3 , avired fees, is received by ailable for inspection at all times at the job site. NO1 12/05