2011, 10-05 Permit App: 11003145 Demo GarageSolan
.#ValleyX
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spoka nevalley.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
1311 -}S -
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: g � S E /" i 55/ON 5 PoKRA/6 a1122(y) 21,4
ASSESSORS PARCEL NO.:
947/Z
BUILDING OWNER NAME:
MAILING ADDRESS:
CITY: n/
STATE: 42)4
zip: 992./2
CONTACT PERSON NAME:
DDuANfir,z
PHONE:
_gog- 9 a6
FAX: CELL: —
CONTRACTOR NAME:
MAILING ADDRESS:
4.
CITY:
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
O Site Plan Provided El Notice of Intent #
❑-' Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
T�HR Cowl I/6RV OLD (x.(446
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 15 the property
owner or has permission to represent the property owner In this transaction. 4) AH 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 taws, codes or ordinances. 6) Plans or additional
Information may be req ired to be submittee and
subsequently•tlapproved before this application can be processed.
Signature . I/, / �{ Date: /0-0.5- o20/)
Updated 1-11-11 Page 1 of 1
http://www.spoka neva I ley. org/filestorage/ 124/938/210/948/ 1496/Demolltion_Permit_1-11-11. doc
-3 0 2C 3C) 4,021,a,
1
004-0
Notice of Intent No. i SpRegiokanonale
Agency Use Only Clean Air,
NOTICE- OF °INTENT
FOR ASBESTOS, PROJECTS / DEMOLITION
ECEIIVE
OCT 0;5 2011
SPOKANE NIREGIONAL
EG NCY
Review Spokane Regional Clean Mr Agency (SRCAA) Regulation I, Article IX acid Section 10.09 for applicable requirements. -
A. Project Type:
•
Asbestos Removal
❑ Asbestos Removal & Demolition
VI Demolition, No Asbestos Removal
Does this project involve a fire -damaged structure?:
■ Yes Q No
(If yes, refer to Sections 9.03.F.3 and 9.08)
Does this project involve demolition by fire training?:
• Yes f S] No
(See Sections 9.02.L, 9.03.F.4 & 9.04.A.6.0
How.many contiguous structures does this project involve?:
/
Maximum of 5 structures per Notice of Intent (NO1)
13. Property Owner:
D IAN F TF -f
Phone:
5225'- 926-1'95-6
Fax:
----
,Mailing Address: ,
,Mailing
-R
•jj5, S I /h I S$. /01/
City: ,
Sft,(ty wiC.0f `/'
State:
pr/a.
Zip:
992, 2
C.'Site-Address
ContactPersohi
2/}m6
Job'SiiePhone:Soy-92c-9Vs-
Strudture #1:
/x, 2,1 Cr E (So - 60 516602.< OAD)
If $:1- structure; provide details to identify
#2:
#3:
'#4:
#5:
D. ❑Material
''Asbestos
Date survey:perforrned:
Pet 9,20/1
AHERABldg. InspectorName:
f<6V1N e9*ce,Nl<
Presumed
Survey:
Was asbestos found?
•
yesf No
Company:
eN,sk /�ANA4emr„
Cert. No.:
(j I P -11. 037
E. Asbestos
Start
f
Completion
For each stricture listed in section C, itemiie the type and
-containing materials to be removed.
Removal
Date.
Date:
quantity of asbestos
Total Linear Feet:
Total Square Feet:
-4043_t
Abatement By (if known):
Will all asbestos -containing material be removed from the structure(s) by the asbestos removal completion date? ,.; I ❑ Yes ❑ No
F. ' Deinolitiori '
Information
Start Date
(earliest)
/0--0.2001
Demolition By
(if known):
Own 2
G. Asbestos Project & Demolition Notification Waiting Period and Non -Refundable Fee Categories (additional categories - pg. 2)
Your advance notification per'od will begin when a completed NOI, including required nonrefundable'fees, is received by SRCAA.
Check / com elete all boxes which a..1 , below.
Owner -occupied, single-family residence (see tbe'Renovation; Demo.; & Asbestos mfo:'sfeet) - Waiting Perio04 ;n :Fee •'-
1. • >_ 10 In ft and/or 2 48 sq ft asbestos .roject not performed by residin • owner Prior Notice $0
2.0 All Demolition (all asbestos must be properly removed and disposed of prior to demolition) .... .;3 Pays „.. . _ .$30
Not owner -occupied, single-family residence �' - " - Waiting Period. :Feet
3. ❑ 10-259 In R and/or 48-159 s. ft asbestos (also for <10 In ft or <48 sq ft per Sect 9.04.A.6.a) 3 Days $250
3.
4. ❑ 260-9991n ft and/or 160-4,999 se ft asbestos 10 Days $500
5. • >_ 1,000 In ft and/or >_ 5,000 sq ft asbestos (see below if z 2,000 In ft or 2 10,000 sq ft) 10 Days $1,250
If 2 2,000 In ft or z 10,000 sq ft, the additional incremental fee added to the $1,250 base fee is calculated as the greater of:
Number of 1,000 In ft increments beginning at 2,000 In ft: _ x $250 = $ + $1,250 base fee =
$
Number of 10,000 In ft increments beginning at 10,000 In ft: _ x $250 = $ + $1,250 base fee =
$
6. ❑ All Demolition (this fee waived if project performed with project category 3, 4, or 5, above) 10 Days
$250
H. Acknowledgement. The Control Officer; or duly authorized representative, shall be allowed td 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 I, Article II and RCW
70.94.200. For the purposes of renovation, demolition, and asbestos projects, reasonable times include, but are not limited to, any pf the following:
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 the 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. 1 certify that the information contained in this
notification and any supplemental information provided is, to the best of my knowledge, accurate and complete.
Business Nam & Address:Fax:
n n r—
Signature: a Print Name: J km /J E A I- 1 F6 Phone So9- 9'2o -y45
_
Agency Use Only:
O NOI Deficient (see page 2)
Complete /0-5-11 $ 4
Date & Initial
,IXNOI
Date & Initial
Page 1 of 2
g
SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828
3/11
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