2006, 07-03 Permit App: 06002575 Demolition MH'T1 )F Permit Center
SV61d e 11707 E Sprague Ave, Suit6 C E V 5 PERMIT NUMBER: �1
4;oo*'�(alle Spokane Valley, WA 9920 D
! PERMIT FEE:
Y (509)688-0036 FAX: 5091.8 0037
Community Development
Residential Construction UNe l nMpficim, ❑ Accessory Bldg
Permit Application ❑ Addition/Remodel ❑ Deck
;,Other:
SITE ADDRESS
ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
Contact,:PerSon
Name:
Phone:
Describe the slope of work in detail:
Contractor..
p/v ` � �
Name:
OAJ
Address: -
,� -35-
3Scity:
city:
zip: Z Z 0
Phone:
Fax: — ,-- 8Q !
Lic No:
p. Date: 12 -3 % b y ,
City Business Lic No:
7
Cost of Project: 1 $ X 600. °-
cn
**************The followinz MUST be complete: (write N/A if not annlicable)**********************
HEIGHT TO PEAK:
DIMENSIONS:.
# OF STORIES:
TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ.
FTG: `QQ Q
2 FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
IMPERVIOUS SURFACE
AREA:
FINISHED/BASEMENT
SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
30% SLOPES ON
PROPERTY:
# OF BEDROOMS:
CONSTRUCTION TYPE:
HEAT SOURCE:
SEWER OR SEPTIC?
DISCLAIMER
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.
Signature
Method of Payment:
❑ Cash
Bankcard #:.
Authorized Signature:
REVISED 8/25/2005
Date 0
permit applications will only be accepted with major bankcard)
Check ❑ Mastercard ❑ VISA ❑ Other
Expires: VIN#:
06/30/2006 14:53 5099283933 IRS ENVIRONMENTAL PAGE 01
606d778616 T-008 P-01/03 F -11D
06-26-06 14:56 FROWSCAPCAON - - ;aPCA
SCAFCA Pf 1 Na. _ Si'OiCP �' ) 0_.G t �e Supe 403l 4Q k]V'1'�Oroe, WA TY Dste F•eceive S
el
Iii ICS C�' INTENT soot
m• �,t
agracy U.ve J Oi T 1sEl� temoroal
A. Pteti �Yt>c% i.• Asbestos Igetaov�{ ANbe8ta5 �ttov0 �c rmatition 3.
9244219 (tf avec a c
13. propom David Whitley Jttb# 8316 Phone; Fax: ..
Owear 9A1727
pmpt rey Ownal 19221 E ®UBitaye C Spomme 11S11@j/ State: WA :i t:
NiatAddress
:C
Addre: 89027
C. Site 18314 E Dalton C SpaK®ne Valley see, 1MA Zi ,
Addrrss: job Sine 924•? 197,
�eypvn,ibte sty. David Whitley pnor,e.
Cantaae Pe"fim _..
ttt+etun:
erfc>tga4d. was as etas lima. ate Survey 8122108 Ne. of 5s• 1
DD- Asbeatoe our or 1 suTvry� tt Su Conduoted: see back if %1
® NiEsiterisl � 1rw If Na AttssCt�titication
1 D219?2 a � �,. 3115/7
AUEAA 11511111 +ng pave Seyiert tvumbsr;
fi Nae $to+rt
Camp 717MIS Wk Days; Su fat aro xh � Sp
>E. Asbestns reject No, of 5tmciurel t3/2WN Date.
i s brlrt>stton � e k if �l 1 Dole: T g
Total quantity anon; n. 140 Will all asbtstos tr+atarittl De No it vrork schedul , 0 Yes
no a t:emoved: feet zemtrved ei a 7 No tltx . be used? Q No
last ittdividnal type acid quantity of O Q1ftri 9 m 12D - ee vlriv , _ .._.. VA anti roafing _ _..._--._--...
be removed or proaitlte an 6tltotttitent of fame: _.. ......._.--
Abatetnent IRS Enviromrnental of WA, int.927.71667
Comracuar: Nttofl®: Pax:
Mailing P® 630x 15216 Shane ValleyState;` zi,
Address: 99215
Ci
mmg trs tList Fine Dept as emo. contr actor
F. 0 911110lftioto tdo. otStructurea: Owl 717100 below]
latreare02HOt►: (sae back if> 1) ® trdned Deatolit{on attach c of Order -
Del !tion Larson's DaM01060wF a0ne. 535l535.kr;g
Contractor:
Matting PO Box 4535 Q Spokane _*11qL WA Zt > 94202
Address• Notificad in Non-h� i„ndable
G. Ashestos/EBetnolltlan jest tratt�asies: ' yes o �/ahln P ease jr; r_Fee
D= Ihls •act itivoive a fuw.dam
1. Owner- ted Restdentiai Asbe9tas RCmova & De mobttan Project' prior dunce ,
® Owner -0C led 1Zeatdential D 4n 4
iD •�'l 5a
2. All erUetmo Hams i No sbe6tos Removal t�Ta act 6 �o
;, • 2591"%W, fart or 08- _-139 s utme feet see back of T rm Par n WWI1 9 u
4. 260; 999 linter feet or 160 - 4,999 , osis Feer 10 �
5. 1.000 - 9.499 linear feet: o0 5.000 - C9 999 square feet 10 Days
6, > 000 linear ar > 50 000 s feet prior NCO=
,•f„� �i Fee
7. AAb f o'txt or Winer 0 01Diem
8. A ale eons o Camlulu+: for Friablo MUCrldis or Danotitton 1 U L7 S Ttuiee t �• lea 1'�' _
B, tetflale ens o 1iat�e foo Namfri>tbEt Asbestos M0KLq!j._1 10 DLYs I\sirc 1;wtect Pee
10. x l+ur fortl•taxardmas Conditions I Castcurtetit With imeel :D1e ula� i,.nicct Fee
clic two cntegorid in t3.1 apply only to owner -occupied, a+r+Ble-Run'iy +�t4enees. which means any non -multiple unit Oa3Etting G,.,1i•,faiDg livIfts
Dirt S'siStlty who owns
splice t1 i is cumntiy occupied culla to alto agar ronptrutCet/tiamolitlnn? oy ttfie 5C/ePCA ss Sir deini479.1 l.� l:,nc at alee rtes to G�9 most be used for all oillee renove+ian/dernolBto+t .leets. For more inform
ltl. 0pdonsl: Ltst Addition+tl parties QB wpgid like enptd4 eftMis NOt aad/oT WPMnotlee9 Sent to (list "al8 MNaumdeT amtLe+l msilil is •I(1mh GsS):
t.arson's f�tnal'R•fon 535.867 ..
Is,
pro
dIn
B. 1 certify talat the information oortteined in this notification clad any suppl®mental ata yidsd to the bast C imp view
It mg�i®n
of my knowledge, aasaurate 01d etmtpletx. loll Ib a;, lent! -
Your advance rQUIC11tion period will begin when a completed NOt, including required flees, is received by SCAPCA.
A cony of the asbestos survcylo C00101etsad natific4tiott & all amendments must be available for inspection at 311 tintf5 8i tftaloh � NOr 1210
RECEIVED 06-$e-01 1909 PR0114-9099263933 T®-4CAP11i PAGE 01