2015, 03-09 Permit App: BLD-2015-0420 Demo Bldg 03/09/2015 MON 10:39 FAX gill 106
Project # ,)1.D 15-69 ()
Community Development Department _ . .V l.
Permit Center
SCTITo
11703 East Sprague Avenue,Suite B-3 PERMIT N Rrt i
Spokane valley,WA 99206
Tel: (509) 720-5240 PERMIT FEE:
IIV Fax: (509)688-0037
"'.aJJ uerrrlltcerlter@snokar1gvallev.org
DEMOLITION PERMIT APPL sue j REV. (—
PROJECT ADDRESS: 550L1lQyei'hte1 S ,o-ka,,,,` Valhi b4.114 11 21
PARCEL NO.: Shah.BUILDING OWNER NAME: Wl��.� /orlifh S rnh-s�Qrfa�'im� - Ea rn D4'.
MAILING ADDRESS: . k /I / : p-% 1 I 1
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CITY: Qnapi� $TATE: ZIP: 9 9x07
CONTACT PERSON NAME: TVA e e Qa r ti i le • - _
PHONE: 50 FAX: ��• ' _ - G G CELL:
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CONTRACTOR NAME: NaerN JIP Sart PI!AInnlhq 40►4 E>��ayrrer.�ier,,z'nL -
HAILING
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ADDRESS: &0 5 1a .t,,
s p 80.0.4
CITY: YV aiJ , I J/ STATE: WP}" ZIP: 1114
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PHONE: ort) l d - 72 o 3 FAX: 5-0 4- 3-2 a 3 8 Z CES N I A.
CONTRACTOR LICENSE No.: 11 ffiuk YJP 435BIk EXPIRES: 01/0 I& CITY BUSINESS LICENSE NO.: j .
P'OiECT DESCRIPTION (Please Provide Site Sketch 40
T+.ht Site Plan Provided Notice of Intent# 15' Q ei
T.:1; Spokane County Utilities has approved the disconnection
bescrI�be the scone of work In detail
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DISCLAIM
The permitted verlfleS,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 fuu 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 :..uired to be submit-d and ubsequently approved before this application can be processed.
Signature j � 4 , ✓1j�/ f ,,igA_ Date: . 3 q ao
Updated 1-11-11 Page 1 of 1
C:\Users\H..). Excavation\Documents\Protects\2015-WSDOT NSC 2015 Demo No 1\Demo_Permit.doc
Received Time Mar. 9. 2015 9: 08AM No. 1566
03/16/2015 MON 11:38 FAX ?008/011
2015-0096 Page 1 of 1
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2015-0096 NOTICE OF INTENT March 6, 2015
Spokane
Notice of Intent No, ClRegen Ai �aycncy I FOR ASBESTOS PROJECTS/DEMOLITION • Date NOI Received
Review Spokane Regional Clean Air Agency(ARCSS)Regulation I,Article IX and Section 10.09 for applicable requirements.
A. Project Type: Demolition.No Asbestos Removal
Does this project involve a fire-damaged structure? NO (If yes,refer to Sections 9.03,F.3 and 9.08)
Does this project involve demolition by fire training? NO (See Sections 9.021,9.03.F.4&9.04A6.f)
How many contiguous structures does this project involve? 2 . Maximum of 5 structures per Notice of Intent(NOI)
Amor
B. Property Owner- Washington State Dept of Transportation Phone: 509-324-6000 Fax: 509-324-6005
Mailing Address: 2714 N.Mayfair Street City: Spokane State: WA I Zip: 199207
C. Site Addrms Contact Person: Mark Johnson Job Site Phone: • 509520.9308
Structure#1; 5504 E4th ST(House) If>I structure,provide details to identify
Structure#2: 5504 E 4th ST(House) Structure#3:
Structure#4: Structure#5:
D. Material Presumed: NO Asbestos Survey: YES Date Performed: December 16,2014
AHERA Bldg.Inspector Name: Todd A.Lewis Cert No.: BIR20140926
Company. Mountain Consulting Services LLC Asbestos Found? NO
For each Structure listed in section
E. Asbestos Removal Stmt Date: N/A Completion Date: N/A C,itemize rho type and quantity of
asbestos-containing materials to be
Do materials include disturbed or non-intact asbestos? NO removed.Mao indicate which
sUvaure(s)will be demolished_
Structure#1: Demolition
Structure#2: Demolition
Total Linear Feet: 0 Total Square Feet: 0 Abatement By(if known):
F. Demolition Information rum Date(earliest): I March 16,2015 Demolition By(if known):
G. Asbestos Project&Demolition Notification Waiting Period and Non-Refundable Fee Categories
Your advance notification period will begin when a cm NOI,including required fees,is received by SRCAA.
Check/complete all boxes which apply.below_
Not owner-occupied,single-family residence Waiting Period Fce
Demolition No Waiting Period $250.00
Surcharge - $9.50
5259.50 paid on 3/6/2015 at 11:28 am
Il. Aknowledgement Name: Carol Johnson Phone: 1 509-525-7203 1
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