2013, 06-17 Permit App: BLD-2013-1122 Demo MHCommunity Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenteralsookanevalley.org
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DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: 18910 E. Marlin
ASSESSORS PARCEL NO.:
J S6�Z. 0kP0
BUILDING OWNER NAME:
Mary Lou Shile
MAILING ADDRESS: PO Box 504
Cm: Liberty Lake STATE: Wk ZIP: 99019
CONTACT PERSON NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME: Larson' s Demolition, Inc.
MAILING ADDRESS:
PO Box 4535
Cm: Spokane STATE: WA ZIP: 99220
PHONE: 5 n 9 S1' —7944 FAX: 509 535-8087 CELL: 509 994-3995
coNTRAcroRLICENSE No.: LARSODI164RU EXPIRES: 12/31/13 Cm BUSINESS LICENSE NO.:600556997
PR ]ECT DESCRIPTION (Please Provide Site Sketch)
Site Plan Provided [B} Notice of Intent #
Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
Demolition/Removal Mobile Home
/3 -OOgS-
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit Is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit Inure to the property owner. 3) The signatory Is the property
owner or has permission to represent the property owner In this transaction. 4) All construction Is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit Is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be requl d to be submitted and sub ently approved before this application can be processed. l
Signature .//44-19, �� Date: // I. / 1 3
Method of payment: 0 Cash
Bankcard #:
0 Check
Ovisa
EXP:
0 -Mastercard
VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\Forms \Building forms\Demolition Permit App.l.doc
NOT TO SCALE
w
Driveway
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18910 E. Marlin
E. Marlin Dr.
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Page 1 of 1
Larsons
From: "Graf, Louis" <LGRAF@spokanecounty.org>
To: "'Larsons'" <larsons@nwadv.com>
Sent: Wednesday, June 05, 2013 9:15 AM
Subject: RE: Sewer Inquiry - Permit Status
Carol,
We do not have sewer in this neighborhood.
Louis R. Graf, Jr., PE/ISIT
Project Manager
Spokane County Div. of Utilities
509-477-7290 Ph
509-477-4715 Fax
From: Larsons [mailto:larsons@nwadv.com]
Sent: Tuesday, June 04, 2013 1:39 PM
To: Graf, Louis
Subject: Sewer Inquiry - Permit Status
Louis,
We have a mobile home demolition at 18910 E. Marlin in the Spokane Valley. Would you please check for the
permit status at this location.
Carol Larson
Larson's Demolition, Inc.
509 995-1910
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Notice ofint halo:
aQ ,icy 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
RI Demolition, No Asbestos
Removal
Does this project involve afire -damaged structure?:
❑ Yes 1Z1No
(Ifyes, refer to Sections 9.0323 and 9.08)
Does this project involve demolition by fire training?:
0 Yes ® No
= (See Sections 9.02.8, 9.032.4 & 9.04.A.6.f)
How many contiguous structures does this project involve? (5
max):
1
(if more than I structure, refer to Section
9.04.A.3)
-
B. Property Owner:
Mary Lou Shine
Phone: I509370 -1234p=
Mailing Address:
pp Rex 5,Q 4
City: k, • berty Lake
State
WA
Zinn:
99019
- -
C. Site Address:
18910 E. Marlin
City:
Spokane Vallestaim
WA I zip:
99027
Contact Person:
Toff r.a.rcr,n Job SitaPhone:994=3995
D. 151 Asbestos Survey or
❑ Material Presumed
Date survey performed:
4/17 / 2013
AHERA Bldg. Inspector Name: Phil Berg
Was asbestos.
found?
10Yes 0 No
I Company:
AAA Oonst, IncCst NO.:
—
BIR -12-055.
E. Asbestos Removal
Information:
Start
Date:
Completion
Dates
Abatement By
(if known):
List individual tygg and
_
200 Sq Ft. Roofing Tar 17dging ' _
quantity of materials to be
-
removed. If>1 structure, list
materials for each structure
Total Linear Feet:
Total Square Feet 1200
by address / location.
Will all asbestos material be removed from the:struchu$(s) by project completion? El Yes [
No
F. Demolition
Information:
Start
Date:
earliest
6/17
Demolition By
{if%wwn):
T.arsons Demolition, , Inc.
G. Asbestos Project and Demolition Notification Waiting Period and Non Refundable Fee Categories
Your advance notification period will begin when a ggingkagN01, including requiredgmagglekk fees, is received by SRCAA.
1. ❑ k 10 Int and/or 248 sq ft asbestos project not performed by residing Darner Prior Notice
2. ❑ All Demolition (all asbestos must be properly removed and disposed of prior to demolition) 3 Days
1: 1I I ,.,ii;rnt r
3. ❑ 10-259 In ft and/or 48-159 sq ft asbestos
13r:ri ie -I'i r
3 Days
80
830
8250
4. ❑ 260-999 in ft and/or 160.4,999 sq ft asbestos
10 Days
8500
5. 0 21,000 In ft and/or a 5,000 sq ft asbestos
10 Days
81,250
6. ® All Demolition
The 8250 demolition fee is waived }f demolition is performed in conjunction with asbestos project category 3, 4 or 5, above.
.dd1tlopal Categories Which May Apply to the Project Categories in 1-6, Above
10 Days
8.250*
1,:11 iCFE' my l (tftll 'SiIU1t .
7. ❑ Emergency
Section 9.04.A.6.h
Prior Notice
Tv/lords Regular Fee
Select the reason that best describes your situation:
❑ Sudden, unexpected event that resulted in apublic health or safety hazard.
0 The project must proceed immediately to protect equipment, ensure continuous vital utilities, or minimize property damage.
0 Asbestos -containing materials were encountered that were not identified during the asbestos survey.
❑ The project must proceed to avoid imposing an unreasonable financial burden.
1'If,;a iii 51s1iu. ossrli fie u.4'
• Nun-t.elp..mlatile
ohne Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / wtvwsookanecleenair.ore / Ph:(509)477-4727 Fax: (509) 477-6828 09/09
8.0 Alternate Asbestos Project Work Practices
; :taus t2oncii?ions
9. ❑ Exception for Hazardous Conditions
Name of person that prepared the Alternate Work Plan:
Section 9.08.A
•
ITrii�rell�`
10 days Twice the Regular Fe&
Waitine Pcriucl IN-Rtlunrlahle Fen *J
Section 9.08.0 10 days Regular Pee
Company he/she represents:
His/her certified AHERA Project Designer No.:
His/her Certified Industrial Hygienist (C1H) number or
Professional Engineer (PE) licensz number.
1?crttniitiutc �t itlt Noufriable._Ltibr.:toz Kaolin°
I0.0 Demolition with Nonfriable Asbestos Roofing
Name of person that determined that mailable asbestos
roofing material could be left in place per Sect. 9.08:B:
Reiercnre
Section 9.08.B
1Vaiti I1 Pcriacl
10 days
:\nn-IictiliulAbte yer_.
Twice the Regular Fee
Company he/she represents:
His/her certified AHERA Project DesignerNo.:
13. Optional: List additional parties you would like copies of this 1901 and/or related notices sent to (list name & fax number and/ormailin i address):
11
L 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 1, Article Il
and RCW 7094200. For the purposes of renovation, demolition, and asbestos projects, reasonable times include, but are not limited
to, any of the fallowing: 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 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 infbrmation provided Is, to the best of my knowledge,
accurate end complete.
Business Name: Larson's Demolition, Inc.
Fax: 535-8087 phones 535-7944
Mailing Addres�:, PO BoX 4535 Spokane, WA 99220
Signature: L Ad �' J 6f1/1 " Print Name: Carol J. Larson, Sec/Treas.
J. Agency Use Only.
0 NNNO1 Deficient
Receipt: 7178 06/05/2013
Acct 11: 424 COPY
Spokane Regional Clean Air Agency
3104 E Augusta Ave
Spokane, WA 99207 5384
Larsons Demolition Inc
PO Box 4535
Spokane, WA 99220-0535
Treasurer's Receipts
Memo 13-0025 18910 E. Marlin
13-0025 18910 E. Marlin 250.00
Non Taxed Amt: 250.00
NComplete Total: 250.00
OI Com
P Chk: 23447 250.00
Date Initial
Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / ►t m
Ttl Tendered: 250.00
Change: 0.00
Issued By: Deb R
06/05/2013 15:49:41
Page 2of_
32$ 09/09
1
Yiligka Maps, Driving Directions, and Traffic
YAHpOL MAPS
aud• I9/tin/sdttuNe/tuo3• 11/i4H
When using any driving directions or map, it is a good idea to double check and make sure the road still exists, watch out for construction. and follow all traffic
safety precautions This is only to be used as an aid in planning
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