2014, 06-12 Permit App: BLD-2014-1364 Demo Residence ....sc_$LD- O' (- i3h (.
Community Development Department Project (Staff Use Only)
Permit Center
Siökaiie 11703 East Sprague Avenue, Suite B-3 PERM1 �/ E D
Spokane Valley, WA 99206
Tel: (509) 720-5240 PERMIT FEE: 13/4
4 °Valley® Fax: (509)688-0037 (VN 1 x(111;
permitcenter@spokanevallev.orq
CSV PERMIT CENTER
DEMOLITION PERMIT APPL TJ 1477 REV # I
PROJECT ADDRESS:11121 E SPRINGFIELD
ASSESSORS PARCEL NO.:45163.0189
BUILDING OWNER NAME:DELBERT BARHAM
MAILING ADDRESS:22708 E 8Th AVE
CITY:LIBERTY LAKE STATE:WA ZIP.== -;a-8710
CONTACT PERSON NAME:DELBERT BARHAM
PHONE:509-998-0396 FAX: CELL:
CONTRACTOR NAME:Louis RAY/RAY'S DEMOLITION
MAILING ADDRESS:P.O.Box 3512
Cmr:SPOKANE STATE:WA ZIP:99220
PHONE:509-924-2040 Fax:509-927-8108 CELL:509-
979-1898
CONTRACTOR LICENSE NO.:RAY**L*19380 EXPIRES:5/13/2016 CITY BUSINESS LICENSE
NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
Site Plan Provided 0 Notice of Intent#2014-0244
0 Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
DEMOLISH FIRE DAMAGED HOUSE.
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 require,0yto submitted and subsequently approved before this application can be processed.
Signature // j)/CA_ Date:6-9-2014
Updated 1-11-11 Page 1 of 1
C:\Users\Patty\Down loads\Demo_Permit.doc
6/3/2014 Spokane Regional Clean Air ' -
Project # Ea)'�� �� f't
RECEIVED
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JUN 12 2014
Spokane
Regional ,� Ag CSV PERMIT CENTER
Clean AirAgency SUB # F-71 REV. #
Curr
Home I About Us I Our Air I Asbestos I Business I Outdoor Burning I Wood Heating I Contact Us Air Qu
Asbestos Asbestos E-NOI(submit,pay online)
Renovation&Demolition
Protects Back to History File an Amendment View Amendments Print
Forms/Publications
Notification&Fee Table E-NOI#2014-0244 teal
Asbestos E-NOI(submit.Day Burn
onlinel Tide Price
Asbestos Service Providers Demolition $250.00
Washington's Asbestos
Labeling Law $250.00 paid on 6/3/2014 8:40 pm "'''
NEW!Asbestos Reaulation Property Information mo.
Changes Approved.Effective 1/SU
September 2.2014 Fire Damaged: No
Owner: Delbert Barham
Phone: 509-891-7575
Fax:
Need Heap? Address: 22708 E 8th Ave
P Liberty Lake,WA 99019
Call OO9)477.4727 Contact Name: Louis Ray
or ESIIIMMI 3ob Phone: 509-979-1898
Structures
1. 11121 E Springfield AVE
to Demolition Only
Asbestos Information
Material Presumed: No
Inspector Name: Phil Berg
Survey Company: Affordable Asbestos Abatement
Certificate Number: BIR-13-033
Survey Date: 3/3/2014
Asbestos Identified: Yes
Disturbed/Non-Intact: No
Asbestos Removal: No
Nonfriable Removal: No
Start Date: 12/31/1969
Complete Date: 12/31/1969
Contactor:
Sob Number:
Contact:
Phone:
Address:
Demolition Information
Start Date: 6/13/2014
Contactor: Louis Ray/Ray's Demolition
Job Number: RAY**L*19380
Contact: Louis Ray
Phone: 509-979-1898
Address: P.O.Box 3512
Spokane,WA 99220
3104 E Augusta Ave,Spokane, WA 99207 • (509)477-4727 • working with you for clean air
httpsJ/spoianecleanair.org/asbestos/e-noi/history/4385 1/2
SCOUIC
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