2010, 04-27 Permit App: 10001185 Demo MHPermit Center
s'Snrr or 11703 E Sprague Ave, Suite B-3
pO rie Spokane Valley, WA 99206
`%sdlley (509)688-0036 FAX: (509)688-0037
J www.spokanevallev.ore
Community Development
Demolition
Permit Application
PERMIT NUMBER: VD._' I h J
PERMIT FEE:S tJG
Commercial
Residential
SITE ADDRESS: / 86 77
ASSESSORS PARCEL NO: 5507/ e 0 30
'Budding Owner' "j "` -g
_
'Contractor
Name: Bret t I+dy r
Name:
Address:/g6;/7 E.Hit 0
»fd jecoAtie
Address:
City: S, ')Lae (la /1 J State:Lour\ Zip: Qq0 ay
City: State: Zip:
Phone: a,-0,./ _3 6a_4/ 1: g Fax:
7
Phone: Fax:
Contractor Lic No: Exp Date:
ContacfpCl$l)n -. __';;i=-;:-t-_.;',`z
City Business Lic. No:
Noy
.Phone:
Name: .9nad /-
Phone: 509_ 9,3v- ej7OO
Describe the scope of work in deta l
/!ri7/ Jar -/e-& /Mgr MUM Slye wick ±vaiLe-t
el A site plan is provided.
o Spokane County Utilities has approved the disconnection.
cif Notice of Intent # /0—OOg7 5g -LA A Lrit}- —91211-
. E, ayscc
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) AH 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
Date q� 7 7Z'
Method of Payment:
❑ Cash ❑ Check ❑ MasterCard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 2/16/07
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h\ -i U "e
1%17 E, liqUieto Ave
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11�- t)r `INIT-NT
APR 2 7 2010
SPOKANE REGIONAL
Notice of Intent Nor, j S octane r t
t pmQtrotA 5ttti W Ii++li_11 r; 'pi N11,11,1.1111> • v, CLEAN AIRACENCY .
Clean ,.: -: - -"'. `` ,: �•. Data Semw- . •
Aymcy Use Only Mirran+cr
I, Article IX --1
Refer to the Agency's Renovation, Demolition, and Asbestos Information Sheet as well as Regulation
A, Project Type:
•
Asbestos Removal
121Asbestos Removal & Demolition
■
Demolition, No Asbestos Removal
Does this involve a fire -damaged structure?:
C Yes S No
(If yes, refer to Sections 9.03.P.3 and 9.08)
project
Does this involve demolition by fire training?:
0 Yes r. No
(See Sections 9.02.R, 9.03.F.4 & 9.04,A 6.0
project
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: 'are'+ 1-}0yr 1Phone:3-09-Z30-9700
Fax:
) eew %.( � City: iS t L'
Mailing Address: 117 /_„ %h�% i� "r'"/
m: LLa
Sta-
Zip: I}'7OZ7
C. Site Address: Ceri/ne, City:
State:
I
Zip:
Contact Person: Thiel /- l—/Rvrz/ NOY? " 509—Z30470O
job Site Phone: --
D
t:4
Asbestos Survey or
Date survey performed
( 1/'2.2."-1 n IAHERA Bldg, Inspector Name:
PA i 1 Bel
❑
Material Presumed
Was asbestos
found?
1 I ® Yes 0 No
I Company: q J �L�t
l iT
Cert. No.:
I % ^04 O20
E. Asbestos Removal
Information:
Start
Date:
/JCompletion
"I .7
IDatet
l9 Z�
Abatement By
I (if known):
-fl? 1 � y
List individual type and
�
6 --F -5, 4— ii;n /
quJntity of materials to be
y
removed. If>1 structure, list
(Total Linear Feet:
6.,
Total Square Peet
-
materials for each structure
by address / location.
Will all asbestos material be removed from the stntcture(s) by project completion? ® Yes NI No
F. Demolition
Information:
Start Date:,,-,
(earliest)
!�
44/— 2-
Demolition By
(if known):
J) rL''-f �
G. Asbostos Project and Demolition
Notification Waiting Period and Non -Refundable Fee Categories
begin a completed NO1, including required nonrefundable fees, is received by SRCAA.
Your advance notification period will when
�r.Ovt iu 0 cigar i; intii f,imll 1L,culuue:t�ee 16L RLuin t(inn D out.fr; L1'\sIN Stu into 'li tt)
rR seting umrl
er #`�>
1. ® Z 10 In ft and/or >_ 48 sq ft asbestos project not performed by residing owner
Prior Notice
$0
2. All Demolition (all asbestos must be properly removed and disposed of prior to demolition)
:,..,,of �nw ID. uL uijirttl ,main resilltnec-c. _ .. ..., - . ..%vanill
3 Days
... 1
30
3. ❑ 10-259 In ft and/or 48159 sq ft asbestos
3 Days
$250
4.
• 260-999 In ft and/or 160-4,999 sq ft asbestos
10 Days
$500
5.
•
> 1,000 In ft and/or >_ 5,000 sq ft asbestos
W Days
S1,250
6. ❑ All Demolition
10 Days
3 4 S
$250*
',kw.
* The $250 demolition fee is waived ifdentolinon is pet ovine to conp+ncnon wun as6e�+o,, gee. category or
,
Additional Categories Which May Apply to the Project Categories in 1-6, Above
r:nicl encvNnlilr, Hun
7. ❑ Emergency
\1 iii n. 1 a nod w'ir` N„n Rcl,ui l dNc�l ce,s
Section 9.04.A.6.h Prior Notice Trice the Regular Fee
Select the reason that best describes your situation:
❑ Sudden, unexpected event that resulted in a public health or safety hazard.
❑ The project must proceed Immediately to protect equipment, ensure continuous vital utilities, or minimize property damage.
❑ Asbestos -containing materials were encountered that were not identified during the asbestos survey.
n The project must proceed to avoid imposing an unseasonable fiaaneia( burden.
Aircrmte \sbc>tos ti Net V4 'ill Pra lilei%f:
12r1rrent r:"' ;Mr ;.,11i41, ul: ' :- Noir Ruin tido I c_,
8. 0 Alternate Asbestos Project Work Practices
Section 9.08A 10 days
Twice the Regular Pee
Page 1 of 2
Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / Ivww.snokanecleanair.or2 / Ph:(509)477-4727 Fax: (509) 477.6828 09/09