HomeMy WebLinkAbout2009, 12-01 Permit App: 09003821 Demolition BarnPermit Center
Siokane
11703ESprague Ave, Suite B-3
ms Spokane Valley, WA 99206
�'Qlley® (509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Community Development
Demolition
Permit Application
PERMIT NUMBER: LA
PERMIT FEE:
n Commercial
n Residential
SITE ADDRESS: Al I 7/ q LO N -
ASSESSORS PARCEL NO:
/2D 503164dvE 1/4 LEy c ,4. 890/6.
Building Owner:
Name: %f/C-oD6,i,E m. 4Lkicez
Address:N 79/9 Lo/YG- /24.
City: 5PokAw�E VALc.-€y State: "it,.Zip:?,70/4.
Phone: 9,/,/z/ _ 5-8 rc. Fax:
Contact Person
Name:
Phone:
Describe the scope of work in detail
RcH 0 vE L34,2N
Contractor:
Name: A/0,e N'S E XC_
Address: ?o 5-7q
City:
State:
Zip 9903 7
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
FSK
o A site plan is provided. ���„ '> , ` %�'J 5C0t_t M
lk
to z( �y Spokane County Utilities has approved the disconnection.
312.°"`:".4o Notice of Intent # t.f7 7 7 2:7 5 CA -Pr
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 �� gL, Date /2 — /— o 9
Method of Payment:
❑ Cash ❑ Check ❑ MasterCard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 2/16/07
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NOTICE OF INTENT
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DEC 0 1 2009
SPOKANE r:r.iaiui 4AL
CLEAN AIR AGENCY
* The $250 demolition fee is waived if demolition is performed in conjunction with asbestos project category 3, 4 or 5, above.
Additional Categories Which May Apply to the Project Categories in 1-6, Above
Emergency' Notification
Emergency
Reference Waiting Period Non-Refundabie Fee
Section 9.04.A.6.h
Prior Notice
Twice the Regular Fe
Select the reason that best describes your situation:
❑ Sudden, unexpected event that resulted in a public health or safety ha7nrd.
❑ The project must proceed immediately to protect equi ment, ensure continuous vital utilities, or minimize property damage.
0 Asbestos -containing materials were encountered thatere not identified during the asbestos survey.
11 The project must proceed to avoid imposing an unreasonable financial burden.
Alternate Asbestos Project Work Practices
8. 0 Alternate Asbestos Project Work Practices
Reference
Section 9.08.A
Waiting Period
lO days
Non -Refundable Fee
Twice the Regular Fee
Page 1 of 2
Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.ora / Ph:(509)477-4727 Fax: (509) 477-6828 09/09
Regional A ` " FOR ASBESTOS PROJE i '
Clean Air4, Date Stain. -A: en Use On
Agency Use Only
Refer to the Agency's Renovation, Demolition, and Asbestos Information Sheet as well as Regulation I, Article IX
A. Project Type:
❑ Asbestos Removal
❑ Asbestos Removal & Demolition
V Demolition, No Asbestos Removal
Does this project
involve a fire -damaged structure?:
■ Yes [$ No
(If yes, refer to Sections 9.03.F.3 and 9.08)
Does this project involve demolition by fire training?:
■ Yes DZI 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:
7 Po ,2G / . A- L/ t't C
Phone:
944- 5-8 SG
Fax:
Mailing Address:
,J. d q 1 y G ogl6. 2D .
City:.
Seo/lAaui' I>4i/ -Y
State:
coA
Zip:
9 q o t 4
C. Site Address:
�A 4/ H
City:
State:
Zip:
Contact Person:
Job Site Phone:
D. R] Asbestos Survey or
Date survey performed:
11 -Zia -01
AHERA Bldg. Inspector Name:
Vre.Wirs1 (Yi` n/)C
❑ Material Presumed
Was asbestos
found?
❑ Yes 4r No
Company:
tz414 °4"10.-'71)-4—'Cert.
P-"Cu-I'i1teNive/tru.-Q
No.:
to B i R- Oct -06I
f..Wine-s 6 -16 -JO
E. Asbestos Removal
Information:
Start
Date:
C I mpletion
Da • :
Abatement By
(if known):
List individual type and
quantity of materials to be
removed. If >1 structure, list
materials for each structure
by address / location.
Total Linear Feet:
otal Sq Feet:
Will all asb os material'• e removed from the structure(s) by project completion? ❑ Yes ❑ No
F. Demolition
Information:
Start Date:
(earliest)
4Z—/— O 7
Demolition By
(if known):
No 'ell -'-s eke.
G. Asbestos Project and Demolition Notification Waiting Period and Non -Refundable Fee Categories
Your will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA.
advance notification period
Owner -occupied, single-family residence (see the Renovation, Demo., & Asbestos info. sheet)
1. [1 >_ 10 In ft -and/or >_48 sq ft asbestos project not performed by residing owner —
Waiting Period
Prior Notice
Fee
$0
2. All Demolitit\(allksbestos must be properly removed and disposed of_prierto demolition)
3 Days
$30
,
Not owner -occupied, single-family residence -
Waiting Period
Fee
3. ❑ 10-259 In ft and/or 48-159 sqltasbestos '"
3 Days
$250
--
4. ❑ 260-999 In ft and/or 160-4,999 sq ft asbes`osr""J
10 Days
$500
5. ❑ >_ 1,000 In ft and/or >_ 5,000 scasb stos
10 Days
$1,250
6. ❑ All Demolition \
10 Days
$250*
* The $250 demolition fee is waived if demolition is performed in conjunction with asbestos project category 3, 4 or 5, above.
Additional Categories Which May Apply to the Project Categories in 1-6, Above
Emergency' Notification
Emergency
Reference Waiting Period Non-Refundabie Fee
Section 9.04.A.6.h
Prior Notice
Twice the Regular Fe
Select the reason that best describes your situation:
❑ Sudden, unexpected event that resulted in a public health or safety ha7nrd.
❑ The project must proceed immediately to protect equi ment, ensure continuous vital utilities, or minimize property damage.
0 Asbestos -containing materials were encountered thatere not identified during the asbestos survey.
11 The project must proceed to avoid imposing an unreasonable financial burden.
Alternate Asbestos Project Work Practices
8. 0 Alternate Asbestos Project Work Practices
Reference
Section 9.08.A
Waiting Period
lO days
Non -Refundable Fee
Twice the Regular Fee
Page 1 of 2
Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.ora / Ph:(509)477-4727 Fax: (509) 477-6828 09/09