2001, 11-15 Permit App: 01010116 Demo ResidenceProject Number: 01010116 Inv. 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date 11/15/01 Page 1 of 2
Project Information:
Permit Use: DEMOLISH RESIDENCE Contact: LARRY JENKINS/INLAND CONSTR
Address: 1620 N MAMER RD
C - S - Z: SPOKANE WA 99216
Setbacks: Front Left: Right: Rear: Phone: (509) 891-5162
Group Name:
Site Information: Prolect Name:
Plat Key: 002748 Name: VERA District: F
Parcel Number: 45104.0213 Block:
SiteAddress: 1616 N MAMER RD
SPOKANE, WA USA 99216
Location.: SPO
Zoning: UNKN Unknown
Water District.
Area: 182,560 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Lot:
Owner: Name
Address
MAMER PROPERTIES, L.L.C.
1620 N MAMER RD
SPOKANE, WA 99216-3722
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review
SCAPA Review
/lib/ s/71-4'
Released By:
Permits:
Contractor: INLAND CONSTRUCTION CO
Address: 1620 N MAMER RD #B
SPOKANE, WA 99216
Item Description
STATE SURCHARGE
DEMOLITION
COUNTY SURCHARGE
Demolition Permit
Firm: INLAND CONSTRUCTION CO
Phone: (509) 891-5162
Units Unit Desc
1 Y OR BLANK
800 SQ FEET
1 Y OR BLANK
Operator: JAS Printed By: JAS
Fee Amount
$4.50
$35.00
$7.70
Permit Total Fees: $47.20
Print Date:
11/15/01
Project Number: 01010116 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 11/15/01 Page 2 of 2
Notes• ,
Payment Summary: ,
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Demolition Permit $47.20 $47.20 $0.00 $47.20
$47.20 $47.20
$0.00 $47.20
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be contrued to be a permit for, or an approval of, any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: JAS Printed By: JAS
Print Date: 11/15/01
AMR
SPOw Cotte
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PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 \VEST BROADWAY AVENUE
SPOKANE, \VG\ 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: ro.a /6' 4-' el,/~72 /C0
Assessor's Tax Parcel Number(s): �{ / 0 4/
Legal Description:
Project Description:
/ tvG V7,Gi 0 (x,44 /4/G,
❑ Building Permit
O Change in Use
O Grading
0 I\ fanufacturcd Home Permit
❑ Relocation
O Sign
O "Tenant (New/Change)
$ Other
..•cpartmch Use Only,. ,'...:
0 Applicant
L 4 C V
Phone
—7 71/k/&f ray
Mailing Address- /�-,,
' 210 /V 4t%fl41�dC /C//
,Water DntncdPonmor
.
Scud lh.mct/Pur:rvora}„. : , . ..
' .
Road width '. -
. r
Setbacks
Front
",Left .'
=
Rear: -
Right .
' School Duma
..
Fire District .
:Zoning •: -
OWNER/APPLICANT INFORMATION
Indiw k who .hm /cI be mnladed n'garIth /bn pmg,/
0 Owner/� a� I'hnne: Z'9/— S/(p Z'
6 7,47 9�\ /&COP” [ILG Fa. 9Z2-72 5/
0 Applicant
L 4 C V
Phone
—7 71/k/&f ray
Mailing Address- /�-,,
' 210 /V 4t%fl41�dC /C//
hlading Atkins:./
S
r26
"'d floor sq. it
Citi, Shoe. /a.
C i &X/,'& ; 4,,,4 9'9
Cm, Date. /.q,
('i mist ucni m type
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Ahulmg address
C/•/7- f/r
Mailing addn..
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\\'A Sure t:omuuor Cons n
Contact name
PROTECT INFORMATION
Building Information
Iiuildntg height to ptak
# of stones
\lain Ile ur ay 0
Lin bmabed babemn ay. 11
Uunonsiuns (�' /t�"J
poral habitable space
"'d floor sq. it
finished ba<rmenl sq. It
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Agency Case No
Agency Use only,
I, Al 111 it I Y
SI'UKANE 0 )1INTY Alli 1'01,1,111.10N CON IRO11
1101 west College, Slime 403, Spokane, WA 99201
NOTICe OF INTENT
TO PERFORM:
--
1 1 lt-mi ecLk1CL#d
NOV 1 5 2001
A en Use Otd
� PtC»t&v: ;JUN1'Y AIR
A. Project Type:
1. ❑ Asbestos Removal
2. ❑ Asbestos Removal & Demolition
3.4Demaly',tjppt IFjI( sNlitra- uta {�
B. Property
Owner: /i'%fl%i% / 0/Q4f T%t tL G
5p9 K9/- Si 6 Z
Phone: ( )
aperty Owner's N• ,#4 4ei 2'
Mailing Address:/b Z /e& �a'
M
City: .5,00,(""✓ /
State: *4
/
Zip: / p%d 341
C. Asbestos PILAFF PRINTCLL4YG1 MIN 14t1BFJOUR RETURN Ao1UNGLABEL
Contractor:
/1,/Contractor:
Contractor
Owner/CEO:
Mailing Address:
q qq
9/- :7/L
Contractor
Job No.:
Phone: (`/) a 2i
�
e' e. r(
Fax: ) 6-615/
City: 5 ' �
a -.
D. Site
Address: /b/U/ ' y �a
City: SAMOIVe
State: wn
Zip: I/74
Manager or
Contact Person: 6/41. 6 Y vCilKNS - INLAND (•N ST,
Phone: ( )89/• .g /6 ZProject
E. Asbestos Survey or
❑ Mat'I Presumed:
No. of/
Structures:
Date Survey was
Conducted: 9/17/8/
Was Asbestos Found? U Yes
)14-IfNoAttach Survey
AHERA Building 'W'WERASURVEY SREQUIRED BEFORE ALL DEMOLITION PRO/ECISFXCFFTAS
Inspector Name: /37-R&VP
PROVIDED BYRCWSII2/20(6) „y.
Certification No.: Oq IS (03
Expirationw»-'-QC
Date:
F. Demolition
Information:
No. of
Structures: /
StartU
Date: 2 H O — I
11 --
Training Fire (List Fire Dept. as demolition contractor below)
❑ Ordered Demolition (attach copy of Order)
Demolition m/yr NAME HERE ENTER MAILINGADDRESS/N BOXJON BACK IF TRAINING BURN ENTERT. ER FIRE DEPHERE
Contractor: Ma -lin ea- ea
�/} �/�
Phone: ( ) %/• 2.
G. Asbestos Project
Information:
No. of Structures:
(see back if> 1) N)A
Start
Date:
Completion
Date:
Wk. Days: M T W Th F Sa Su
Hours:
Total Quantity to be Removed: Linear Ft. Square Ft.
Will all asbestos material be U Yes
removed byproject completion? 0 No
Thermal System Insulation:
0 Boiler\Fumace Ins. U Duct Ins. U Pipe Ins.
Other:
Surfacing Mat'l: ( U Fireproofing U Paints U Plaster 0 Textured Coatings
Other:
Mise. Mat'I:
U Cement Bd. U Cement Pipe U Flooring Mat'I U Roofing Mat'I
Other:
H. Asbestos/Demolition Project Categories:
I. 0 Owner -Occupied Residential Asbestos Removal & Demolition Project
0 Owner -Occupied Residential Demolition Project, No Asbestos Removal
Notification
Project Fee
NON-REFUNDABLE
Waiting Period
$25
Prior Notice
2.,$ All Other Demolitions With No Asbestos Removal Project
ail
' $150%
3. U 10 - 259 linear feet or 48 - 159 square feet (see back of form for options)
150
4. U 260 - 999 linear feet or 160 - 4,999 square feet
10 Days
$300
5. U 1,000 - 9,999 linear feet or 5,000 - 49,999 square feet
10 Days
6. U > 10,000 linear feet or> 50,000 square feet
10 Days
$1750
500
7. U Emergency Asbestos Project or ❑ Emergency Demolition Project
Prior Notice
Twice Project Fee
8. U Alternate Means of Compliance for friable materials or U Demolitions
10 -Day Review Period
Twice Project Fee
9. U Alternate Means of Compliance for nonfriable asbestos materials
Concurrent with Project
Twice Project Fee
I. 1 do hereby certify that Me information contained in this notification, and supplemental data described herein, is to the best of my Completeness Review
knowledge accurate and complete I shall not cause or allow any asbestos project or demolition activities to begin until the Performed By
appropriate waiting period has elapsed
•
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'�Ak
Signature Representing Vat`
Agency Use Only
Vonre o/lruent (66.160BR) 2/9S 12/99