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2009, 06-12 Permit App: 09001722 Demolition GaragePermit Center San or 11703 E Sprague Ave, Suite B-3 oka`nee Spokane Valley, WA 99206 Valley® (509)688-0036 FAX: (509)688-0037 www.spokanevalley.org Community Development Demolition Permit Application SITE ADDRESS: PERMIT NUMBER: - PERMIT FEE: n Commercial Residential (1ZZ ASSESSORS PARCEL NO: 5 (Sr I • Building Owner: P 5 Name: ti ) tiL t4 rc n ✓ 7.3SP� �r Address: D � (, (:) 62. City: r J � le_cl )711 State: we) Zip:/ 21 - Name: 5ayr oI )/j4.0 i L idI City B�siness►��Liic��. 6e)) 3 /93 Address: 27 ),/ City: ,----'' Ste: Zips ,a f LL phone:c_323 8.4i Z, Fax: ContactJrson Name: 5© di l _� ✓ ���L{ �Ylii Phone: G9 O 32c- 2%) Describe the scope of work in detail Contractor: v� l(' Y ` 4i yl &L33 41iL1 G Name: ti ) tiL t4 rc n ✓ 7.3SP� �r Address: D � (, (:) 62. City: r J � le_cl )711 State: we) Zip:/ 21 - Phone �,/.3Zg-276Z Fax: (55)la Contr ,Q�:, tgr/ci * ,,,7.,50i CExp Date: 0/_ 03--Y' ))No: City B�siness►��Liic��. 6e)) 3 /93 A site plan is provided. Spokane County Utilities has approved the disconnection. Notice of Intent # 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 • . nces. Ownership esulti develop ent ranted by any issued permit inure to the property owner. Signature Date ©6—/2— 09 Method of Payment: ❑ Cash ck Check ❑ MasterCard ❑ VISA Bankcard #: Expires: VIN#: Authorized Signature: REVISED 2/16/07 Untitled Page General/Specialty Contractor A business registered as a construction contractor with LEd to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name GEOMETRIC DESIGNZ Phone 5093262760 Status Address PO BOX 6062 License No. License Type Effective Date Expiration Date Suspend Date County SPOKANE Specialty 1 UBI No. Suite/Apt. City State Zip SPOKANE WA 99217 Business Type Parent Company Individual Specialty 2 601378193 ACTIVE G EOMED* 973OC CONSTRUCTION CONTRACTOR 9/3/2003 9/3/2009 GENERAL UNUSED Business Owner Information Name Role Effective Date Expiration Date CORKRUM, RUSSELL OWNER 09/03/2003 Bond Bond Information Page 1 of 2 Insurance Information Insurance Bond Bond Effective Expiration Cancel Impaired Bond Received Bond Company Account Date Date Date Date Amount Date 6 Name Number 12/11/200712/11/2008 $300,000.00 12/13/2007 2 AMERICAN CONTRACTORS 100038878 12/17/2007 Until $12,000.00 12/24/2007 4 INDEM CO INSFB6783 09/02/200609/02/200701 Cancelled /08/2007 $900,000.00 08/08/2006 1 CBIC FB6783 09/02/200312/17/200710/17/2008 $6,000.00 09/03/2003 Insurance Information Insurance Company Name policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 7 PREFERRED CONTRACTORS INSURANC PCIC5026PCA792412/11/200812/11/2009 $1,000,000.0012/03/2008 6 PREFERRED CONTRACTORSPC4929 INS 12/11/200712/11/2008 $300,000.00 12/13/2007 5 ATLANTIC CAS INS CO LO65006288 12/28/200612/28/2007 $300,000.00 01/16/2007 4 CBIC INSFB6783 09/02/200609/02/200701 /08/2007 $900,000.00 08/08/2006 t,+,-...,,. i ...el NI /1 ._�, in .,.;i ,, ,r., 4/1')/')CtC%C Untitled Page Page 2 of 2 3 CBIC INSFB6783 09/02/200509/02/2006 Status Violation Amount P37582 $300,000.00 08/25/2005 2 CBIC INSFCB6783 09/02/200409/02/2005 $300,000.00 08/31/2004 1 CBIC INSFB6783 09/02/200309/02/2004 $300,000.00 09/03/2003 Infraction / Citation Information Infration/Citation Date RCW Code Type Status Violation Amount P37582 8/18/200418.106.020 (5)(b) RCW PLUMBER INFRACTION Satisfied $250.00 t.,++...,..ii1'1i')nnn * The $250 demolition fee is waived if demolition is performed in conjunction with asbestos project category 2 3 4 b , or , aove. H. IL I. I certify that the information contained in this notification the best of my . , wledge accurate ant com61- e.��� Business Name - 1 ► % • .I SI 1...11j . -. NOTICE OF INTENT _ JUN 2009 SPOKANE.-:� ION ,L .1A .% •r; Mailing Ad.. Signature: ( Notice of Intent No. Spokane ' f'`~ti` CLEAN AIF AGENCY Agency Use Only Regional � t,?. FOR ASBESTOS PROJECTS / DEMOLITION � , " Clean Ai r„.Date Stant, - A: en Use On Refer to the A • ency's Renovation, Demolition, and Asbestos Information Sheet as well as Re l ulation I, Article IX A. Project Type: ❑ Asbestos Removal ❑ Asbestos Removal & Demolition ) Demolition, No Asbestos Removal 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 structures does this project involve?: 2 (If more than 1 structure, refer to Section 9.04.A.3) B. Property Owner: 'C 0 Phone:(M ,3-84! Fax: Mailing Address: Ai/`i_. 4 City: ^ I J A i State: 1 . Zip: r All C. " Site Address: I • i r► 4 _ ,' A . P City: ek..41 a, l State: A „ Zip: _ Contact Person: " iA . p i k \ 1^ amu yyj P (1 ee io »ii f 1 . I 1 +' Job Site Phone: ))326- �j► D. .Asbestos Survey or I Date survey performed: 05/0410 �� � RA Bldg.Inspector Name: p Q S �' Material Presumed Was asbestos found? ❑ Yes Ll oto Company: 14)S'ii tyr Cert. No.: 131R O7- 0)4 E. Asbestos Removal Information: D , . v -- i r Co ... • • . Date: • — 2 Abatement By (if known): - '. , moor ---,..n, Pa 0 b �' -; '' . List individual type .. d quantity of materials to be / CRC i removed. If >1 structure, list materials for each structure by address / location. Total Square Feet: Total Linear Feet: Will all asbestos material be removed from the structure(s) by project completion? ❑ Yes ❑ No F. Demolition Information: Start Date: tt�� (earliest) 6�2� V Demolition By (, l (if known): W 4 ),I a rky iuJl, 6n �13WI G. Asbestos Project and Demolition Notification Waiting Period and Non -Refundable Fee Categories Owner -occupied, single-family residence (see the Renovation, Demo., & Asbestos info. sheet) Waiting Period Fee 1. ❑ All Demolition (all asbestos must be properly removed and disposed of prior to demolition) 3 Days $30 Not owner -occupied, single-family residence Waiting Period Fee 2. ❑ 10-259 In ft and/or 48-159 sq ft asbestos 3 Days $250 3. ❑ 260-999 In ft and/or 160-4,999 sq ft asbestos 10 Days $500 4. ❑ >_ 1,000 In ft and/or >_ 5,000 sq ft asbestos 10 Days $1,250 5. tiA11 Demolition 10 Days $250* Additional categories ❑ I have completed and attached the Supplemental Notice of Intent (NOl) for emergency, alternate asbestos project work practices, demolition with nonfriable asbestos roofing, or exception for hazardous conditions. * The $250 demolition fee is waived if demolition is performed in conjunction with asbestos project category 2 3 4 b , or , aove. 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. I certify that the information contained in this notification the best of my . , wledge accurate ant com61- e.��� Business Name - 1 ► % • .I SI 1...11j and any supplemental information provided is, to '%'b �-)`�2�-Z(iiiiNOI �. ht� Phone: Completeness Review complete U NOI deficient - See/Attached, (2/ )/6q &:: .1A .% •r; Mailing Ad.. Signature: ( _ C2 -.s � Ufr l ! Print Name: �ir1,�.j� 11 Co }' k rRy-yl .�� ..Yj Agency Use Only Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207-5384 / www.spokanecleanair.org / Ph.: (509) 477-4727 Fax: (509) 477-6828 Your advance notification period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA. NOl 11/08 Giv‘e.e.i,LcuLreA reet aCrO5 Oct 1 a G. DYlCI P,/. cJ