2011, 02-22 Permit App: 11000422 Demo Garage Community Development Department (Staff Use Only)
Permit Center (�
SCITY OF 11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER: f I-V4n
pokane Spokane Valley, WA 99206
Valle Tel: (509) 688-0036 PERMIT FEE: (7 I
Fax: (509) 688-0037 ✓
Y permitcenter(•isiokanevalley.orci
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: t/62 9 S.., /0,4-y kr,en.) 0
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME: ' 4. 4(J 4 L L Ivo •1 ( :b'1 -O
MAILING ADDRESS: /` al „4y 4-1--el /e0
CITY: S7.2/4-4 N[_ V t / STATE: /F ZIP: / 5d1 6 C
CONTACT PERSON `7 NAME: c Qu, CT/W `77— %6 le-/ )
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PHONE: S ' �- / V7 FAX: — CELL:
CONTRACTOR NAME: �i
MAILING ADDRESS: S L J
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
El Site Plan Provided ❑ Notice of Intent #
Et Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
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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 submitted and su equently a ove efore this application can be processed.
Signature Date: D/aal/
Vl�
Updated 1-11-11 Page 1 of 1
http://www.spoka neva)ley.org/filestorage/124/938/210/948/1496/Demolition_Permit_1-11-11.doc
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Notice of Intent o. Spokane Y\�-_
NOTICE OF INTENT FEB 18 2011
�'I
Regional FOR ASBESTOS PROJECTS/DEMOLITION
Agency Use Only CLean AlrAgency SFICNOWiegamate Only
Review Spokane Regional Clean Air Agency(SRCAA)Regulation I,Article IX and Section 10.0= . ��. . '�'-
A. Project Type: ❑ Asbestos Removal ❑Asbestos Removal&Demolition Li Demolition,No Asbestos Removal
Does this project involve a fire-damaged structure?: 0 Yes i„ Np. (If yes,refer to Sections 9.03.F.3 and 9.08)
Does this project involve demolition by fire training?: 0 Yeso (See Sections 9.02.R,9.03.F.4&9.04.A.6.f)
How maiiy;contiguous structures does this project involve?(5 max): (If more than 1 structure,refer to Section 9.04.A.3)
B. Property Owner: P/ 5CP I,41—;Ai lb�,_tb Phone: ,,$a9 609/-974 Fax: •
Mailing Address: s. .247 en --.d City: Se: Zip:
C. Site Address: /
5 , /14.1441 City: Stat: Zip:04— a
6'1]
Contact rson: /SSC u9 t,h p '77b-e. o Job Site Phonq:567 89/ —9
D. Asbestos Survey or Date survey performed: . /i 7/a o t l AHERA Bldg.Inspector Name: Phil 43 e-
❑ Material Presumed Was asbestos found? ❑ Yes ID,No Company: 40.`e,.J4.giy Cert.No.: d.LI2—to -O z3
E. Asbestos Removal Start Completion Abatement By
Information: Date: Date: (if known):
List individual type and
quantity of materials to be
removed.If>1 structure,list
materials for each structure Total Linear Feet: Total Square Feet:
by address/location. Will all asbestos-material be removed from the structure(s)by project completion?❑ Yes ❑No
F. Demolition Start Date: ,molition By C /L I'
Information: (earliest) / If (if known): J
G. Asbestos Project&Demolition`b'l+itic 'ion1Waiting Period and Non-Refundable Fee Categories(additional categories on pg.2)
Your advance notification period will begin when a completed NOI,including required nonrefundable fees,is received by SRCAA.
Owner-occupied,single-family residence(see the Renovation,Demo.,&Asbestos info.sheet) Waiting Period Fee
1. ❑ >_ 10 ln ft and/or>_48 sq ft asbestos project not performed by residing owner Prior Notice $0
2. A All Demolition(all asbestos must be properly removed and disposed of prior to demolition) 3 Days $30 •
Not owner-occupied,single-family residence Waiting Period Fee
3. ❑ 10-259 ln ft and/or 48-159 sq ft asbestos(also for<10 ln ft or<48 sq ft per Sect 9.04.A.6.a) 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 10 Days $1,250*
6. ❑ All Demolition 10 Days $250**
H. Optional:List additional parties you would like copies of this NOI and/or related notices sent to(list name&fax number and/or mailing address):
I. 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 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 of 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.I certify that the information contained in this notification and any supplemental
information provided is,to the best of my knowledge,accurate and complete.
Business Name: Fax: Phone:
Mailing Address: v n /� /�
Signature: Print Name: 1, 6 U4-L=.I f)O I 2i u
SRCAA,3104 E.Augusta Ave.,Spokane,WA`99207/www.s okanecleanair.or /M/7;4727 4727 Fax:(509)477-6828 9/10
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