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2013, 07-01 Permit App: BLD-2013-1288 Demo MHSpokane ./ 7alley Pro;^r t 60-3— Z 5 Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 CSV Tel: (509) 688-0036 Fax: (509) 688-0037 Dermitcenter@spokanevallejv iar VED PE 2r,hStaff Use Only) PERMIT NUMBER: r14'Fir-41-riCf4iLl T E R DEMOLITION PERMIT APPLICATION PROJECT ADDRESS: 5 ilk /✓oey ASSESSORS PARCEL NO.: BUILDING OWNER NAME: Ate J 7/AN,r71.c MAILING ADDRESS: / 2. / 74/ /' STATE:c%�((— 'tel./J CITY: ,©ka✓le %� CONTACT PERSON NAME:j�/ GQ)/J /tJ G� PHONE: ii// 3 -72 7/ ZIP: z aI FAX: CONTRACTOR NAME: J r p `¢���,0 CELL: MAILING ADDRESS: 5„,t i_ e CITY: S STATE: ZIP: PHONE: FAX: CELL: CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.: PROJECT DESCRIPTION (Please Provide Site Sketch) ❑ Site Plan Provided 0 Notice of Intent # ❑ Spokane County Utilities has approved the disconnection Describe the scope of work in detail ri/ 1-7 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 required to be submitted and subsequently approv-. before this application can be processed. Signature ent: Method of pay ElCash Bankcard #: El Check Date: DVisa El Mastercard EXP: VIN#: Authorized Signature: Effective October 28, 2007 Page 1 of 1 P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Demolition Permit App 10.28.07.doc Project .;:,13(A,--(3 -raiz R. LE) Ec1uv n JUN 1 2 2013 4/3-�ze d r ONAL Notice of Intent No.Spokane Agency Use Only el :ll �' Dl 31 ' '. -' ` \'1;i 1 O 1'Ia).11 ( 1-S, 1)1 \U,; 111()\ Datems-Agency Use Only 6540 + SP Q O Alt ` ' e i f :i a - eNI c e ► , .an• ` •Q'O= forapphcab7e equrr_ .. s A. i Projeet type j ❑ Asbestos RemovakJIB [i .1klestos ReMilVitlf&Dem_lolition I J.i 1' Demolition, No Asbestos Removal Does this project" nVOYve a fre-damagecisiructure? '7-13 J Yea • • to Sections 9..03.P.3end 9.ij8} Does this,project involve demolition by fire training?: ■ Yes [ErNo (See Sections 9.021 9.03.F.4 & 9.04:A.6.f) How manY. eontiguouss. . T oes tlus`pmject'involve?: / NM nn_ium;of 5 structures _ per Notce.of Intent.(NOn B. Property Owner: - : :R t c I j r /rJ U iters S Phone: q l `/- 7 s5 `/ Fax: --- MailingAddress:: M.6"7-3 Aport,.e QA, City: ti,e via.le%t State: AV tiip _ -u1"7 C. Site Address `Contact Person:? « i eA..,.r./f rn Critat.t , Job Site Phone: 1,-2—V-141,--'1. Struct<ue`#l: i(1 / 7 .5,yc / ore— j-fc.--. S i-►yvd [If>1 structure, provide details to,ideutify. #2:. #3; 4: #5: D. • Material Presumed ❑ Asbestos Survey: Date survey_performeil•' • AHERA Bldg. Inspector Name:1 Was asbestos found? . ■ Yes ■ No Company ` I Gert. No, E. Asbestos ; Removal Start Date: Comp'1etion. `" Date 'For each tiicivreliste m section C,`itemite t e.type and quantity ofasbestos-contai• ning materials to be removed. � Do materials include disturbed ornon= ntact asbestos? ' i D Yes f 'No Total-Lrnear Feet: 14')!31' Total SquareReet ;( IAbafemet_By (iflgown),: Will •allasbestos-containing matenal be removed from the stnicture(s) by:the asbestos unioval comdate? ate? 0 Yes ❑ No F. Demolitton l`nformation -' Start Date (earliest) Tro 1'j•C,i', - 4 `� 1i- e%/K- r Demohtion By Ciiknowia): i1? o -c C a/ f 7 ti Su N, I G. Asbestos Project 4. -P04101100 -NO ication waiting Period and Non -Refundable Fee Categories (additional categories-.pg.:2). Your advancenojtific� ; einod Will begin,when a. completed NQI, including b dog required nonrefimdable fees, is received by SRCAA. Check (ho 1. � (.com fete all boxes; -. ilii .. a:4! tiedo +..: ner-occupied. •in< ie-tantilreiilclicc (, . t11e i:enoN atiun, Demo.. & ,1,c,10. into..liect) ■ >_ 10 hi ft and/or >_ 48 sq ft asbestos project not performed by residing owner \\ aitiw2, Period PriorNotice Ice $0" 2. !:! All Demolition all asbestos must be • • per ly removed and di . . sed of . rior to demolition) Not im Iter-oCCupiCd, ,lit,iC-i.iinilrctdenlc 3. ❑ 10-259 In ft and/or 48-159 sq ft asbestos (also for <10 In ft or <48 sq ft per Sed 9.04.A.6.a) 3 bays \N iitil-w. Period :3 Days $30 1. ee $250 '. 4. ■ 260-999 In ft and/or 160-4,999 sq ft asbestos IQ Days .' $500 5. ❑ >_ 1,000 In ft and/or 2 5,000 sq ft asbestos (see below if >_ 2,000 In ft or 210,000 sq ft) 10,Days - ,• $1,250 If 2 2,000 In ft or 210,000 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 R x $250 = $ + $1,250 base fee = $ Number of 10,000 sq ft increments beginning at 10,000 sq ft: x$250 = $ �+ $1,250 base fee = $ 6. ❑ All Demolition (this fee waived if project performed with project category 3, 4, or 5, above) ( i 0 Days ;: $250 '' .• H. Acknow . _kdg emeat. The -Contiof Officer, ar duly authorized ve,'shall be allowed to access .propatyat reasonable times to insPect projects :: specific to the eontrol,•reoovay, or release of oonis into the atmosphere, in accordance with SRCAA Regulation 1, Article -Band. RCW 7(p4,20,0.. Forthe: , , ofrenova Purposes ., atron,-deinohticin, and asbestospropels, ressgnable times include, but are sot limited to, any of the following: when renovation, demohti*or asbestos removal appear to be occvrrmg or are-scieduled to.ocairi andrtanes wheat the Control Officer orgy authorized representative are investigating air quality complaints filed with the agency and/or.have teak& to believe that"air quahtyviolations have; ., occurred prim be ocauriag: No,person shall obstiiict, -hamper or interfere with any such inspection. I certify that the information contained m this' ., notification and any supplemental information provided is, to the best of my w]mo " .complete. " ledge. aavrate and Business Name & Address: Fax: Signature: )(Q. • P%ri r' -'t--,%. Print Name: f , 1,-. litir c, tut. (5 Phon,S• 92-61- 7., -SL, Agency (Ise:Only tJ N_(SI Deficient. (see page 2) (Date & initial) NOI Complete Dat&Inlrisi) ' Page 1 of 2 SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828 4/13 SCIMAP Project # 13 r t3 ^ (zeg RECEIVED 93.2 9 i 46.58 93.2 Feet O This map is a user generated static output from an Internet mapping site and is for reference only. Data layers that appear on this map may or may not be accurate, current, or otherwise reliable.