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2009, 06-12 Permit App: 09001720 Demolition GarageSpokane jValley® Community Development Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www.spokanevalley.org Demolition Permit Application SITE ADDRESS: PERMIT NUMBER: 0 I PERMIT FEE: Commercial Residential 120 ASSESSORS PARCEL NO: Building Owner: I 5 Name: r r .0 ,C( lilMA Address: 274 k) b ..„) a' ,1 ."state: (� City: ti > Zip ` ZD7 0.)411 Phone: _, — [j t-12_ Fax: Contac erson Name: Phone: (.0) l .ov'krrA.141 326- 2T CO Describe the scope of work in detail Contractor: podc( (O K`flJ 11/1)0,4,421 tw -ri Name: l 1e .un �°.7 iiz Address: J ) ` ( u ED6 2 / City: t State: ij , ^� Zip:q /` 77G Phon 1 p132c_ 2t(9�) Fax: c��Lf' Contrdct Exp Date: ��©Li��R�;3� l` �`b3�� City B s 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 rdinances. Ownership of,{esulti g dev lopmer}#'t'jg s granted by any issued permit inure to the property owner. Signature Method of Payment: ❑ Cash Bankcard #: Authorized Signature: gCheck REVISED 2/16/07 /WM/ Date n6-/2-0' ❑ MasterCard ❑ VISA Expires: VIN#: Untitled Page General/Specialty Contractor A business registered as a construction contractor with LELI 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 UBI No. 601378193 DESIGNZ Phone 5093262760 Status ACTIVE Address PO BOX 6062 License No. GEOMED*9730C Suite/Apt. License CONSTRUCTION Type CONTRACTOR City SPOKANE Effective 9/3/2003 Date State WA Expiration 9/3/2009 Date Zip 99217 Suspend Date County SPOKANE Specialty 1 GENERAL Business Individual Specialty 2 UNUSED Type Parent Company 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 7 Name Number $1,000,000.0012/03/2008 2 AMERICAN CONTRACTORS 100038878 12/17/2007 Until $12,000.0012/24/2007 INDEM CO Cancelled 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 PREFERRED 7 CONTRACTORS PCIC5026PCA792412/11/200812/11/2009 $1,000,000.0012/03/2008 INSURANC PREFERRED 6 CONTRACTORSPC4929 12/11/200712/11/2008 $300,000.00 12/13/2007 INS 5 ATLANTIC CAS L065006288 12/28/200612/28/2007 $300,000.00 01/16/2007 INS CO 4 CBIC INSFB6783 09/02/200609/02/200701/08/2007 $900,000.00 08/08/2006 411 '1 11!11(1 Untitled Page 3 2 1 CBIC I NSFB6783 09/02/2005 09/02/2006 CBIC CBIC INSFCB6783 09/02/2004 09/02/2005 INSFB6783 09/02/2003 09/02/2004 Page 2 of 2 $300,000.00 08/25/2005 $300,000.00 $300,000.00 08/31/2004 09/03/2003 Infration/Citation Date RCW Code Type Status Violation Amount P37582 8/18/200418.106.020 (5)(b) RCW PLUMBER INFRACTION Satisfied $250.00 /1 nnn i * The $250 demolition fee is waived i}'demolition is performed in conjunction with asbestos project category 2, 3 or 4, above. 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 the best of my . . wledge accurate an. com.l Business Name..;A • '1 . 1 i i . N ' A NOTICE OF INTENT •1 1' I spoKANL Notice of Intent No. . ce.10N -:L Spokane �� CLEAN AIR AGENCY Agency Use Only �,,k. FOR .ASBESTOS PROJECTS / DEMOLITION Regional 4�'t�;- ' Clean Airs, Date Stamp -Agency Use Only Refer to the Agency's Renovation, Demolition, and Asbestos Information Sheet as well as Re . ulation I, Article IX A. Project Type: ❑ Asbestos Removal ❑ Asbestos Removal & Demolition - . - _ A"1/14 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) 13. Property Owner:S Phone- ;1323 841 Fax: Mailing Address: ► �i_ , voirCity: _4/ , _ 4 I State: , 4,, Zip: V r C. Site Address: I • . d r i . , ' i _AM . ;,, .�.1i • 1', State: , „ Zip: /, % i � Contact Person: l gaS! i/ `l1:lr�WM _ f ice,,; 'NIVii. ) �� Job Site Phone: gp;, ..- 4, D. ►_i Asbestos Survey or i Material Presumed Date survey performed: 00 0; kid,' Id • RA Bldg. Inspector Name: ke.311, Cert. No.: i h • . — I Was asbestos found? ❑ Yes GI oto Company: ' A r, ' .1 i E. Asbestos Removal Co [i a • . Abatement By . itillin Information: D • •. i : -- • ° Date: f — w ti (if known): ' r Ty 4 y v Jr ; ;/ List individual type - d C.. I C quantity of materials to be removed. If >1 structure, list materials for each structure Total Square Feet: Total Linear Feet: by address / location. Will all asbestos material be removed from the structure(s) by project completion? ❑ Yes ❑ No F. Demolition rn: Start Date: 0 ? (earliest)b�2�V(11 Demolition By( n Qiir \ ,rk1ubYI p13 4 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. 6fAll Demolition 10 Days $250* Additional categories ❑ 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. * The $250 demolition fee is waived i}'demolition is performed in conjunction with asbestos project category 2, 3 or 4, above. 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 the best of my . . wledge accurate an. com.l Business Name..;A • '1 . 1 i i . notification - e. Ji l.. and any supplemental information provided is, to b 2 01)32c-2 411 JA 4_ Phone: Completeness Review OI complete 0 NOI deficient - SeAttached /e f &A.. /6q /3( .1 r //- Mailing Ad.. 01b2. Signature: p :.L t).l Print Name: 1.13,j•2A C.-Orkru %f I - . - _ A"1/14 Agency Use Only Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207-5384 / www.spokanecleanair.ore / 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. NOI 11/08 0 Oo Y1 C,c»j 3.0-r rao 3 CYC Va.