2011, 03-28 Permit App: 11001011 Demolition MHStiaane
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
.ermitcenter • s.okanevalle
.or
(Staff Use ti, --1.0\
Only)
PERMIT NUMBER:
PERMIT FEE:
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: v
ASSESSORS PARCEL NO.:
93g gi 44 Ci r t -
BUILDING OWNER NAME:
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MAILING ADDRESS:
5 93)%� 4 C..- -
CITY: K 1" ` / 44.i STATE: b/ % 4,(F3 ►-\
CONTACT PE SON NAME: /f OA j
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ZIP:
PHONE:
CONTRACTOR NAME: // r/I
MAILING ADDRESS: 65--.4-,3
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PHONE: FAX: J CELL:
CONTRACTOR LICENSE No.: V0+�/1 o ;'JC51 y% EXPIRES: 77//'/// CITY BUSINESS LICENSE NO.:
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Fax:
CELL: 9? 3-,E3
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STATE:
G,/,,d ZIP: ?soli 2_
PROJECT DESCRIPTION (Please Provide Site Sketch)
Site Plan Provided El Notice of Intent #
St Spokane County Utilities has approved the disconnection
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pISCLAIMER
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 f any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be required to be sd sequently approved before this application can be processed.
Date: 3 4V)
Signature
Updated 1-11-11 Page 1 of 1
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SPOKANP COUNTY
SPOKANE COUNTY
DEPARTMENT OF BUILDING & PLANNING
1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050
Site Information
Project Information
Site Address: 934 S NINA CIR
Parcel Number: 45203.0126
Subdivision: RANGE
Block: Lot:
Zoning: UNK Unknown
Owner: PEARSON, JASON
Address: 934 S NINA CIR
SPOKANE, WA 99206-3104
Building Inspector:
Water Dist:
Project Number: 11001163 Inv:
Permit Use: SEWER ALTERATION
Applicant: VORTEX INC
6923 E 8TH
SPOKANE, WA 99212
Contact: VORTEX INC.
6923 E. 8TH AVE.
SPOKANE, WA 99212
Setbacks - Front:
Group Name:
Project Name:
1 Issue Date: 4/5/2011
Left: Right:
Phone: (509) 879-7362
Phone: (509) 879-7362
Rear:
1
Permits
Sewer Connection Permit
Contractor: VORTEX INC License #: VORTEI*099PT
ALTERATION TO EXISTING 1 $125.00 PROCESSING FEE 1 $25.00
Total Permit Fee: $150.00
**FOR SEWER INSPECTIONS CALL THE UTILITIES DEPT AT (509) 477-3604 FROM 8:30-5:00 MONDAY -FRIDAY PRIOR TO
COVER. ONE WORKING DAY NOTICE REQUIRED. PERMIT ALLOWS FOR A 30 -MINUTE INSPECTION. ADDITIONAL
INSPECTION FEES APPLY AFTER 30 MINUTES.
**CALL 1-800-424-5555 BEFORE YOU DIG --AT LEAST 2 WORKING DAYS IN ADVANCE. SPOKANE COUNTY CODE
REQUIRES THE INSTALLER COMPLY WITH ALL REQUIREMENTS OF THE WA STATE DEPT OF LABOR & INDUSTRIES,
INCLUDING THOSE RELATED TO TRENCH SAFETY.
**INSTALLER IS RESPONSIBLE TO INSURE ALL WASTEWATER DRAINS ARE CONNECTED TO THE SEWER AND MAY
BE REQUIRED TO PERFORM TESTS FOR VERIFICATION. INSTALLER IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION OF SEWER STUB PRIOR TO ANY OTHER EXCAVATION.
**SEWER STUBS AND DRY SIDE SEWERS ARE TO BE CHECKED PRIOR TO CONNECTION TO ENSURE THAT THEY
HAVE ACCEPTABLE GRADE AND ARE CLEAR AND UNOBSTRUCTED. SEWER LINES SHOULD BE CONSTRUCTED TO
ALLOW FOR GRAVITY FLOW FROM THE LOWEST LEVEL OF THE STRUCTURE.
**THE INSTALLER AND THIS PERMIT MUST BE PRESENT AT THE JOB SITE AT THE SCHEDULED INSPECTION TIME.
BOTH STATE LAW RCW 19.122 AND COUNTY CODE REQUIRES THE INSTALLER TO GIVE NOTICE OF EXCAVATION TO
OWNERS OF UNDERGROUND FACILITIES.
Payment Summary
Total Fees AmountPaid AmountOwing
$150.00 $150.00 $0.00
Tran Date Receipt # Payment Amt
4/5/2011 1073 $150.00
Processed By: CUMMINGS, KATHY
Printed By: Force, Faith Page 1 of 1
PERMIT
•
Notice of Intent No. i Spokane
Agency Use Only ? Regional ,
Review S . okane Re • Tonal Clean Air A • enc(SR
NOTICE OF INTENT
FOR ASBESTOS PROJECTS IDEMOLTTION
A. P a.. cab
Project
RCELIVE
C
APR 13 2011
SPOKANE REGIONALC EAN AIR AGENCY
Date tamp - e
ncy_ se In y
CAA) Re:ulation I, Article IX and Section or i
10 09 f 1
ect Type: ❑ Asbestos Removal ❑ Asbe
Does this project involve a fire -damaged structure?:
Does this project involve demolition by fire training?:
How many contiguous structures does this project involve?:
stos Removal & De - f r '
re. uirements.
ion L� Demolition, No Asbestos Removal
yes, refer to Sections 9.03.F.3 and 9.08
�►'�ji ee Sections 9.02.L, 9.03.F.4 & 9.04.A.6.0
Maximum of 5 structures per Notice of Intent (NOI)
Phone: "9 36—F g Fax:
Contact Person:
Job Site Phone:
If>1 structure, provide details to identify
D. ❑ Material
Presumed
E. Asbestos
Removal
Total Linear Feet:
a'Asbestos
Survey:
Start
Date:
Will all asbestos -containing
F. Demolition
Information
Date survey perforined:
Was asbestos found?
Completion
Date:
AHERA Bldg. Inspector Name:
otnpany:
For each structure listed in section C, itemize the type and
• uanti of asbestos-containin • materials to be removed.
Abatement B if known :
structure(s) by the asbestos removal completion date?
=►etnolition By
(if known): �1G
G. Asbestos Project & Demolition Notification Waiting Period and Non -Refundable Fee Categories (additional categories -.
Your advance notification period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA.
Check / corn lete all boxes which a..1 , below. pg 2)
Owner -occupied, single-family residence (see the Renovation, Demo., & Asbestos info. sheet) Waiting period Fee
I . 0 >_ 10 In ft and/or > 48 sq ft asbestos project not perforined by residing owner
2. ❑ All Demolition (all asbestos must be properly removed and disposed of prior to demolition)
Not owner -occupied, single-family residence
3. 0 10-259 In ft and/or 48-159 sq ft asbestos (also for <10 In ft or <48 sq ft per Sect 9.04.A.6.a
4. 0 260-999 In ft and/or 160-4,999 sq ft asbestos 0 Days
5. 0 >_ 1,000 In ft and/or >_ 5,000 sq ft asbestos (see below if 2,000 In ft or >q ays
10 Days
If > 2,000 In ft or >_ 10,000 sq ft, the additional incremental fee added to the $1,,250 base fee is calculated 1as the greater of:
Number of 1,000 In ft increments beginning at 2,000 In ft:
Number of 10,000 In ft increments beginning at 10,000 In x $250 = �+ $1,250 base fee =
6'•1g All Demolition (this fee waived if project perforined with project tegory 3, 4, or 5, abov
H. Acknowledgement. The Control Officer, or duly authorized representative, shall be allowed to access prop(
specific to the control, recovery, or release of contaminants into the atmosphere, in accordance with SRCAA
70.94.200. For the purposes of renovation, demolition, and asbestos projects, reasonable times include, but
when renovation, demolition, or asbestos removal appear to be occurring or are scheduled to occur, and time:
authorized representative are investigating air quality complaints filed with the agency and/or have reason to
occurred or may be occurring. No person shall obstruct, hamper or interfere with any such inspection. I certif
notification and any supplemental infonnation provided is, to the best of my knowledge, accurate and comple
Business Name & A 1/ a
Signature:
Prior Notice
dress:
gency Use Only:
❑ NOI Deficient (see page 2
k' S
❑ NOI Complete
CAA, 3104 E. Augusta Ave., Spokane, WA 99207 / wwty Date &Initial
Date &Initial
snokanecleanair ot'e / Ph:(509)477-4727 Fax: (509) 477-6828
$1,250
r
ax:
Phone: Sz 71. 736Z
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