2009, 11-23 Permit App: 09003745 Demo Sheds . Community Development Department (Staff Use Only)
Permit Center
Spokane 11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
Spokane Valley, WA 99206
Valley Tel: (509) 688-0036 PERMIT FEE:
Fax: (509) 688-0037
permitcenterOspokanevallev.orq r„
DEMOLITION PERMIT APPLICATION
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PROJECT ADDRESS: 1 ' 'O8 I Ulm iej W c
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ASSESSORS PARCEL NO.:
BUILDING OWNER NAME: 3cuai $ NIL() ?/untih
MAILING ADDRESS:! J i L �S D g E 1 IaJ.L 4d c�1^ J� �j /°�2
CITY: � . �J° / ' (/ STATE:(/ Val ZIP: "/Qv J7
CONTACT PERSON NAME:
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PHONE: 50q— qq 0 - 61(0 3 FAX: 50q-22(0-/914 CELL: 5Oq—,22' -3g24
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
la Site Plan Provided ❑ Notice of Intent #
❑ Spokane County Utilities has approved the disconnection
Describe the scope of work in detail em
Knoc
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 r approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be mitt a subsequent! approved before this application can be processed.
()Signature I)) Date:
Method of payment: ❑ Cash ❑ Check ❑Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\Forms\Building forms\Demolition Permit App.1.doc
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06)- ,• 0361 \,) Ii( '1 . , )i' 1 \ !'I,_:\ i ~ NOV 202009 1
Nexkeof ladiVo.i , SPOKANE REGIONAL I
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wail, Lawn piroft4
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_ Refer to the - t s or�ttio�Detaofff#an,and Asbeste�l iforeaafion Reel a a , >F on IX
A, Project Type: 0 Asbestos itetnoval 0 A*butoa Ransoviit• i-nation tion I Demolition,No Minutes Remove[
Does thk ., . inve C a , -,structure?: ';"' _ �' os, :, -.i.,.i '0031 and Mt
Data this, ,oct involve demolition by flee, . ,:`: U Yes ,.: • , .sca Serttk0s 9.02.1t,9.0.3.1.4&9,04,A.6.
Hog many contiguous structures does this project involve?(5 x4 f (If most nem I tticture,refer to Section 51.04.A.3)limen; o�
B. P �, "Owners F 1 UFF/WiT 1 t.•,:. Y''CD/d-
a._Addcoss: /d k Pis' , llA'cz..T YlA/i "Z. . : 7,4. ("lir stithr r+ 1- .-`r•4,6
G SiteAddreaa: +'4 r WV Lc& t'j$i y: '0 _. Sty '- Zap: "rj?7
D. G os$aroey or Data _ perfumed: . 1:' : „: Inspector Nome- it i r l 800
❑Material Presumed Wm tabes d Yes Li o Camp*ny: Cart.No.:
E. Asbestos Removal Start Com, enols Abatement Ey
informadeat Date. r t*; a 1 .,,Li
•
List individual fym and
gtratrtity of neatesrials to be111111V.W1�.I, T
remould.if>I lttttt:urk US
materials tor each structure . l fue er Peet: Total S. Peet: 111111.1
by adisees/location. Will ell aSbupsto, "al be removed fir the svnotureN , ,.•`act ,.Action?I Yen I No
F Demolition Start Date: i,/� Demolition By i't j /
informntieni earliest I it ' if known
IG. Asbostos Project and Demolition Notification Waiting Yierlod and Nate-Refuntlable Fee Categories
Your advance notineslinu period will begin when a *,..Lu. ...-,.NO1,including requirad�l a it recalved by BRCA.A.
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i1v•i,,r n,.u1,i1.,.-i1tc1- :.,(i,tl', 1/11,I..r lr; 11:, 1a Luz'.aunt.l)0`11:••...\• .t,:n'• ..Cif,. , r- • 1.1..ilii:-- 1'01,1 1
i,O. i In it and/or Z 4$80 ft asbestos project not perrermed by restd eg owner Prtoree $0
2. ei All Demolition(all asbestos must be properly removed end disposal of prior to detnalitlon) 3 Deys $30
\u;„• nv,-uec.,,p;',I. •,,+plr i:,,.,:lr ,1•r.i,i,u„ V, r:11e, Po::,:.I I::.
3.0 10.239 to ft sndlm 48,159 s4 ft asbestos 3 Days $250
4.❑ 260.999 f:'ft aadtor 160-4,999 sq ft asbestos 10 Days I $500
.
S.0 1,000 In ft and/or.5,000 eq ft asbestos • 10 Days $1.250
S.0 All Demolition 10 Days $250"
e The$1J demdltloafee ft ivegvad ffdsruotitirm it 04'8r-tried in conjunction with cabarets ed category3,4 or R ahoy.
Additional Categories'Which May Apply to the Project Categories in 14,Above
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7.0 E icy Section 9.04A.6.h Prlor*ticc .
Select the reason that best destaibcs your situation, -
0 Sudden,unexpected event that resulted in a p<tbiin health or s thele herd- -
❑The prajeot must proceed kromedisoly to protect equipment,mat condrgioes vital rrtaias,or tatiattaht,property dometm.
I Asbestos-c b—nte'lxalog materleb were
�a e�yeex+ub�ta�ratl that ware net identified during the aebeatoa survey. •
• 71. .. .M �1, 'i 7..,to LVe1td.i.,, .t•••t�financial burtiem.
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\I,�ru.tr,- _i,:-Iy. l'r,.tn1 1,.,;,�':..i�. - --
11.D Alternate Arbeatos Project wokPrao!tlaes Section 9.08-A 10 days Ttvict the Regular Pee
Page 1 of 2
Spokane Clean Air,3104 E.Augusta Ave.,Spokane,WA 90207I4yww.zq okaarfs I Ph:(509)471.4721 Pax:(509)4774828 09109
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9.0 Exception for Hazard=Cemdltlovt Section MC 10 days Regular PCG
)datree Of •• that • •- the Abtauste Work Plee:
C.'< Wake -'resents:
Hlgibar c'edifled AHEM Paled Dastigner Noz 1111111111111.11111111111111111111111111111111111111111111
Higher Cawed industrial H►gfealSt( numbs or
Fhtlhasionat Iioearta number:
Il,-n,.:' 4 n:c ..,tit .,f •.I.i, .-�,1.,1<r f', r.,. _ i(,.t., .4.-4:. P::i... ...1: i::'uu.:C..;;. 1..
10.❑Demolidne with Ncar&isbfe Mbeeioe Roofing Seaton 9.0 10 days 1r►'!R R:'!!= '*!
• Name Of pe son drat determined itit tsesrsfrieble asbestos
roof.1 material could Im tett in 1 ,• •.. Sect 9.08.3:
Miele • ti;
Histtrer certified ified AfMU • . Doty,- No.:
It Optimal:List additional pieties you would its eropirs oldie kn a ad/or:eke d settees seat to$.-tans R ftmliumber aiulin malting
. - _- - -
{I. Aehnowledgeuunt
The Control Offiosr,or duly authorized representative.shall be allowed to access property et reasonable times to inspect projects
spccdre tel the control,recovery,Cr rislease of contaminants into the atmosphere,in accordance with 2CJ A Regutatta t t,Adicle lI
and RCW 7094.200. For flus purposes of renovation,demolition,and asbestos projects,remoneble times include,but are not limited
to,any of the following:when renovation,demolition,or asbestos removal apps to be oceturing of are etedultdi m occur,and tames
when the Centel CMffcer or duly authorized representative are iaveetlgating air quality complaints filed with waxy and/or;haft
reason to believe that air gttality violations have Deemed or may be occurring.No person shall obstruct.hkmper or Interferewfth any
such inspection,
I coney that the information contained in this notification and any supplemental information provided is,to the best of my iasowle dge,
accurate end complete,
Business Name: Pax. _ Fisons -
Moiling Address: � .d �i/>` /
Signature: �j .� �/�"j " • Print Plane: c/ 1/ a_kn k)
447141 Cr" .
NOI Dtflcient:
•
NM Complete__ 121, b g <{
1 ft
Page 2 of 2
Spokane Clean Alt,31043.Augusta Ave.,Spokane,WA 99207! /Ph:(509)477-47f71~att:009)477-682S t9M
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11120/2009 14:22 5092261167 PAGE 09112
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