2012, 05-18 Permit App: BLD-2012-0677 Demo Garage r _ _ , Community Development Department (Staff Use Only)
Permit Center
SonWm "^ a 11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER: old—i2-6 7 7
Spokane Valley, WA 99206
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Valley Tel: (509) 688-0036 PERMIT FEE: . 2 I
44000vFax: (509) 688-0037
Dermitcenter@sookanevalley.orq
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: '-Z ( , (ECL-� .
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME: UM-2- �s Ar;L E4Q-A0 L i2.-
MAILING ADDRESS: 412- I • C/E-re ia 7'-b .
CITY: -- /n A k-g_ / T - STATE: /424. ZIP: ?92--/ K
CONTACT PERSONNAME: 6U - c�IJ-
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.
PHONE: 'x/'63, FAX: CELL:
CONTRACTOR NAME: 6 wiev
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
' CONTRACTOR,LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
Rs ECT DESCRIPTION (Please Provide Site Sket h) 0°z- k
D Site Plan Provided
Notice of Intent # C 2: -
104 Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
_-Mu sl ,/e ,4-77-01-T-CL 2P
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 subsequently approved before this application can be processed.
Signature Date: - I ,ES 7-c) I?_
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Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Demolition_Permit_1-11-1.1.doc
TECEIIVE ----
Z OZ( , NOTICE OF INTENT MAY 1 2012
Notice of Intent No. Spokane
Re ionat 40 05;'' FOR ASBESTOS PROJECTS/DEMOLITION SPOKANE REGIONAL
Agency Use Only �tePfl A11-n _cY. ..,....—:41...11!..A....d Las•
Review'Spokane Regional Clean Air,'Agency(SRCAA)Regulation Ii.Article IX and.Section.10,09,for applicable TO uirements.
A. Project Type:. ❑Asbestos Removal ❑ Asbestos Removal&Demolition ya Demolition,No Asbestos Removal
Does this project involve a fire=damaged structure7; 0 Yes 1K1,No ,(If yes;refer to Sections 9.03.F.3 and 9`:08)
Does this project involve demolition by fire training?: 0 Yes ®No `(See Sections 9.02..L,9.03.F.4&c 9.04.A.6.0
How many contiguous structures does this project.involye?: i ;Maximum'of 5•structures per Notice of Intent(NOI)
B. Property Owrier: tC L e- '1.- _ Au I Z_ 1?hone: f ,5 FaX:
Mailing Address; 4F.2-1 $, cG1 . City; 5.. e(/4-/f State: I./}4 Zip: 9�6=/6:
C. Site Address Contact Person: (?, 4_p .e_S /c1 e-o,r4 o( . Job Site Phor::e;
Structure#1: � � .7�-�/ ��'�
2.ar-5'�. If structure,provide details to identify
#2: #3:
#4: #5:..
D. ❑Material ®Asbestos Date survey performed: —(b—I 2- AH �ERA Bldg. Inspector Name: i f CI--3' s
Presumed Survey: Was asbestos found?_ ❑ Yes No Company:t,,1_4(.4te(164.= Cert.No.:
E. Asbestos Start Conipletidn For oath structure'listed in section C, itemize the type and
Removal Date: Date:: quantity of asbestos-containing materials to be removed.
Total Linear-Feet: Total Square Feet:. Abatenient By(if kriowri):i: _
Will all asbestos-containing material be removed frrom,th'e structures)by the asbestos removal completion date? I ❑ Yes ❑ No
r
F. Demolition Start Date:`, Demolition By •
Information (earliest) � �1 -..."cif known) .
G. Asbestos Project&Demolition Notification Waititig Periiod and Non-Refundable:Fee Categories(additional categories-pg.2)
Your advance notification period will begin when.a.completed NOI,including required nonrefundable fees,is received by SRCAA.
_Check/coin.lete,all;bo2ces,.whichi a..1,;.below., ...:..
Owner-occupied,single-family residence(see the Renovation,Demo.,&Asbestos info.sheet) I r Waiting Period Fee
1. ❑ >_ 10 In ft and/or>_48 sq ft asbestos project not performed by residing owner Prior Notice $0
2.E All Demolition(all asbestos must be properly removed and disposed of prior to demolition) 3 Days $30
Not owner-occupied,single-family residence I !I Waiting Period Fee
3. ❑ 10-259 In ft and/or 48-159 sq ft asbestos(also for<10 In ft or<48 sq ft per Sect 9.04.A.6.a) 3 Day:; $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(see below if 2,000 In ft or>_ 10,000 sq ft) 10 Days $1,250
If>_2,000 In ft or> 10,000 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 ft: x$250= $ I+$1,250 base fee=_ $
Number of 10,000 In ft increments beginning at 10,000 In ft: x$250 $ I+$1,250 base fee= S
6. ❑ All Demolition(this fee waived if project performed with project category 3,4,or 5,above) 10 Days $250
H. 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 releaseOf contaminants into the atmosphere,in accordance.with SRCAA Regulation 1,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 beoccurring.o 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 havereason to.believe that air quality violations have
occurred or may be occurring.No person shall obstruct;hamper or inter`fere.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& ddress: [�k41 A. e'7✓�v(- . '24 S 'u�'c_( f>- Fax:
Signature ,./,� . ,. ___�, J Print Name: Phone:72-"I `LO
Agency Use Only:
0 NOI Deficient(seeZ e 2) ❑ NOI Complete —
Date&Initial Date&Initial Page I of 2
SRCAA,3104 E.Augusta Ave.,Spokane,WA 99207/www.spokanecleanair.org/Ph:(509)477-4727 Fax: (509)477-6828 3/1/