HomeMy WebLinkAbout2010, 12-03 Permit App: 10003952 Demo MHSpokane
,,;00Valley®
Community Development
Demolition
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www. spokanevalley. org
Permit Application
SITE ADDRESS:
ASSESSORS PARCEL NO:
Building Owner:,
• .. �/.
Contact Person
Name:
Phone:
Describe the scoter -of work in
PERMIT NUMBER: Z
PERMIT FEE: LV e7.—
❑ Commercial
Residential
Contkactor: .
Name:
Address:
City: State: Zip:
Phone: Fax:
Contractor Lic No: Exp Date:
City Business Lic. No:
K A site plan is provided.
5z Spokane County Utilities has approved the disconnection.
o Notice of Intent # 1 y-0.112=7
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 grant d by any issued permit inure to the property owner.
Signature Date /.�2
Method of Payment: //
❑ Cash ❑ Check ❑ MasterCard [ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 2/16/07
COPY
•.__......__._'y ... ................ ........ _._.._.._...__.___..._..._......_f _.."__.___._
10_ 0 4'b �_�1 . �r
_.....� _ _ _ _ _
D
D
Notice of Intent No. Spokane ��� >FOR ASBESTOS , •
NUV 10 2010
Agency Use Only _Clean Al rAgency
_ Date Slam p -Agency Use
Review Spokane Regional Clean Air Agency. (SRCAA) Regulation I, Article IX and Section 10.01
for, li
Asbestos Removal &Demolition olition, No Asbestos Removal
A. Project Type: El Asbestos Removal ®A❑Dem
Does this project involve a fire -damaged structure?:
❑ Yes ® No (If yes, 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 contiguous structures does this project involve? (5 max): 1 (If more than 1 structure, refer to Section 9.04.A.3)
B. Property Owner:
Dave Seyfert
I Phone:
1509.926.4060
1Fax:
None
Mailing Address:
514 S. Arc
City:
Spokane Valley
State:
W
Flp.
99016
A
C. Site Address:
18604 East Dalton
City:
Spokane Valley State:
W
I Zip:
99216
A
Contact Person:
Dave Seyfert Job Site Phone: 998.8258
D. ®Asbestos Survey or
jDate survey performed: 11/01/2010 AHERA Bldg. Inspector Name: Dave Seyfert
❑ Material Presumed
I Was asbestos found? 10 Yes ❑ No Company: I I Cert. No.:
1106112
E. Asbestos Removal
Tstart
11/22/10
Completion
11/27/57]Abatement
By
Dave Seyfert
Information:
I Date:
Date:
if known):
List individual type and
Silver paint on roof
quantity of materials to be
removed. If>1 structure, list
materials for each structure
Total Linear Feet: ITotal Square Feet: 1710
Will all asbestos material be removed from the structure(s) by project completion? ® Yes ❑ No
by address / location.
F. Demolition
Start Date: 11/24/10
Demolition By Larson Demolition
Information:
(earliest)
(if known):
G. Asbestos Project & Demolition Notification Waiting Period and Non -Refundable Fee Categories (additional categories on pg. 2)
Your advance notification period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA.
Owner-occuoied, .. 1 i i
1. ❑ >_ 10 In ft and/or >_ 48 sq ft asbestos project not performed by residing owner Prior Notice $0
2. ❑ All Demolition (all asbestos must be properly removed and disposed of prior to demolition) 3 Days $30
residenceNot owner. occupied , sin le-famil Waiting Period Fee
3. ❑ 10-259 In ft and/or 48-159 sq ft asbestos (also for <10 In ft or <48 sq ft per Sect 9.04.A.6.a) 3 Days $250
4. ❑ 260-999 In ft and/or 160-4,999 sq ft asbestos 10 Days $500
5. ❑ >_ 1,000 In ft and/or >_ 5,000 sq ft asbestos 10 Days $1,250*
6. ® All Demolition 10 Days $250**
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):
I. Acknowledgement. The Control Officer, or duly authorized representative, shall be allowed to. access property at reasonable times to
inspect projects specific to the control, recovery, or release of contaminants into the atmosphere, in accordance with SRCAA
Regulation I, Article II and RCW 70.94.200. For the purposes of renovation, demolition, and asbestos projects, reasonable times
include, but are not limited to, any of the following: when renovation, demolition, or asbestos removal appear to be occurring or are
scheduled to occur, and times when the Control Officer or duly authorized representative are investigating air quality complaints filed
with the agency and/or have reason to believe that air quality violations have occurred or may be occurring. No person shall obstruct,
hamper or interfere with any such inspection. I certify that the information contained in this notification and any supplemental
information provided is, to the best of my knowledge, accurate and complete.
Business Name: Fax: Phone:
Mailing Address:
Signature: Print Name: Dave Seyfert
® NOI Deficient (see page NOI Corriplete [ Ho -Ig
Agency Use Only:
Page 1 of 2
SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / wwlv.spokanecleanair.or / Ph:(509)477-4727 Fax: (509) 477-6828 9110
Heather Morris
From:
Rivers, Roger [RRivers@spokanecounty.org]
Sent:
Friday, December 03, 2010 11:41 AM
To:
Permit Center
Cc:
'dks9741 @comcast.net'
Subject:
Demo Permit
The mobile home scheduled for demolition located on the property at 18604 E. Dalton IS NOT CONNECTED to
the Spokane County Sewer System. Therefore, a sewer abandonment permit and sewer abandonment
inspection by the Spokane County Division of Utilities IS NOT REQUIRED. Please call me @ 477-7682 if you
have any questions.
Roger Rivers
Customer Service Representative, Spokane County Division of Utilities