2009, 08-11 Permit App: 09002586 Remove, Replace Roof on Half of Duplex•
Permit Center
11703 E Sprague Ave, Suite B-3
p��J1l�ille Spokane Valley, WA 99206
�• (509)688-0036 FAX: (509)688-003a 8N
� www.spokanevalley.org
�GG�O NEVAt-L�
G\-v‘iOr
pu
Community Development
Demolition
Permit Application
Te
PERMIT NUMBER:a ,0 \
PERMIT FEE:
mmercial
Residential
<ice
SITE ADDRESS: ei t.2 5 iD ,` C, X ,e
ASSESSORS PARCEL NO:
Building Owner:
/
Name: r1 y t 1 r'� \/O cl-PC-
Address: l7 cs7/ y tj A) elt ) c IRA
City:A„e_a r c ,t.' L K State: 0. Zip: 110
10 2:
Phone, O 9 9/0 003'1 Fax. D°9 2e/e1 t//!v /
Contact Person
Name: ct.r ( r - '/t, c,r
Phone: col- 11'00 8 3 7
Contractor: O Wirs `e -(-
Name:
�
Address: 1 _ 4-
M
J
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
.
Describe the scope of work in detail
.Q,wt o v ,e r o o P P rv--v‘ e -7` M P f"
D R -P I wee
o A site plan is provided.
o Spokane County Utilities has approved the disconnection.
o Notice of Intent # \t,w(L `R,\ate Ut &`r -
The permittee verifies, acknowledges and agrees by their signature that: 1) Ownership of this City of Spokane Valley
Permit inure to the property owner. 2) The signatory is the property owner or has permission to represent the property
owner in this transaction. 3) All construction is to be done in full compliance with the City of Spokane Valley
Development Code. 4) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or
local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signature � e Date $ 1 I• 09
Method of Payment:
❑ Cash ❑ Check ❑ MasterCard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 2116/07
05/18/20139 16:18 5099283933
IRS ENVIRONMENTAL
PAGE 01
co,
y 1l
z � Li.x D) i 11 C
NO'TICf `
�eNoticeofItitentNo.
Agency Use Only
} OF INTENT
Spokane i y j j MAS( 19 2009
r, Regional tai s FOR `SRF,STOS PIWJC'CTSVDFMOLITION . 1
Clean Air'Aoony Fw--x.“-'4ry I ;.rr Mn ; p .t Fi (:7nb
Mailing Address: PO Box 15216 ..k:ne Valle WA • •21
See Attachedhedr
:)yA
C
Refer to the Agency's Renovation, Demolition, and Asbestos Information Sheet as well as Regnfatiottp fr c e
A. Project Type:
❑ Asbestos Removal
9
0.1
Asbestos Removal & Demolition
❑ Demolition, No Asbestos Removal
Does this project involve a fire -damaged structure?: fi Yes 0 No (lfyes, refer to Sections 9.03.F.3 and 9.08)
Does this project involve demolition by fire training?: • Yes ® No (See Sections 9.02.R, 9.03.F.4 & 9.04.A.6.f)
How many structures does this project involve?: 1 (If more than 1 structure, refer to Section 9.04.A.3)
B. Property Owner: Debbie Adams
Job # 11714
Phone:
Fax: 661-252-2872
Mailing Address: 28063 Florence Lane
City: Canyon View
State: CA
Zip: 91351
C. Site Address: 918 S Dickey Rd
City: Spokane Valley
State: Wa
Zip: 99212
Contact Person: Marlin Yoder
Job Site Phone: 990-0837
D. ® Asbestos Survey or
Date survey performed: 3/26/09
AI-IERA Bldg. Inspector Name:
Todd Lewis
❑ Material Presumed
Was asbestos found? ® Yes
•
No
Company:
MCS
Cert. No.:
BTR -09-034
E. Asbestos Removal
Information:
S art
Date: 6/1/09
CompletionAbatement
Date: 6/2/09
By
(ifknown): IRS
List individual
quantity
type and
of materials to be
140 SF Sheet Vinyl
removed. If> ] structure, list
materials for each structure
by address 1 location.
Total Square Feet: 140 Total Linear Feet: ..
Will all asbestos material be removed from the structure(s) by project completion?
/ / Yes ❑ No,:;
F. Demolition
Information:
Start Date:
(earliest) 6/2/09
Demolition By
(if known): Larson' s
G. Asbestos Project and Demolition Notification Waiting Period and Non -Refundable Fee Categories
`<Ownet occupied sin Ile-fauuly t esidenie (su. the Renov rutin, Dino '& Ashestos Info sheet)
*.Waiting Pcrto_d
1. ❑ All Demolition (all asbestos must be properly removed and disposed of prior to demolition)
3 Days
$30 :.:
ti 110teRnl'..... iedZsin le Iatuil reialencc '4 '' ` t 'n -xR� �w-
• P g ,.) x --*�+ . > . ,.
'�-Wait-mg
_ Period
'c
.fcc
2. N. 10-259 In ft and/or 48-159 sq ft asbestos
3 Days
$250 :>
3. ❑ 260-9991n ft and/or 160-4,999 sq ft asbestos
10 Days
5500 -..
4. ❑ > 1,000 In ft and/or? 5,000 sq ft asbestos
10 Days
$1,250 -,
5. ■ All Demolition
10 Days
$250'”--'
y ,y<a�i.: d." �§ `a� - "Y `.. *k•
1ddirion'It a 1 egoriC x"t�- •
.. i.`,w. a- s.. -Fd _ .>_ -_ .. __ s '.._ x.^jN �x1'. 4� ... it .5 -+
•
I have completed and attached the Supplemental Notice of intent (NOI) for emergency, alternate asbestos project work practices,
demolition with nonfriable asbestos roofing, or exception for hazardous conditions.
emotition fee is waived ifdemolwon is performed in conjunction w/th asbestos. rotect at
H. Optional: List additional parties you would like copies of this NOI and/or related notices sent to (list name & fax number and/or mailing address):',
Canon's Demolition 535-8087
I. 1 certify that the information contained in this notification and any supplemental information provided is, to the
best of my knowledge, accurate and complete.
usiness Name:TRS Environmental of WA, Inc. Fax: 509-92$-3,33 Phone: 509-927-7867
BSee
c repleteness Review
u NOI complete
0 NOIdtf, -
cient
Mailing Address: PO Box 15216 ..k:ne Valle WA • •21
See Attachedhedr
:)yA
1
9
51/VD?
Signature:
1 i
k ,1*
.
11 f
WWW 1/ ,
//
-
t Name: Wendy Nixon for Dave Seyfert
-,
.,
gxrnc7, use Ony.:
Spokane Clean Air. 1191 W. Collepe. Suite 401 Spnknno WA 99201 / www.spokanecleanair.org / Ph.: (509) 477-4727 Fax: (509) 477-6828
YRece1ved Time;aMay.,18._d2069seo4_:2]PMallo: 519.1 NOT, including required nonrefundable fees, is received bySRCAA.NOI iJV8