2009, 12-23 Permit App: 09004079 DemolitionPermit Center
• 11703 pra Ave, Suite B�
ane Spokake Valley,kWA 992061,/("
® (509)688-0034,F� o sg'ooY1
�4 Valley www,Spoka;i6V eSr:or'�►°'' CENTER
Communis ty Development
DE 2
Projact # • _ (77
Demolition !Name_ Commercial
Permit Application'm'�f �'' — _ _ ._— Residential
i
SITE ADDRESS: I31-111 £ SIH 4 tJ t 4Po 14A7JI Or , W �a 99Z/6
ASSESSORS PARCEL NO: 2-1";ZZ I . 05Da
Building Owner:
Name: ...w7611-1-1--rtyyi kRA CA -!Ai et 1.41,
Address: 15,11 Z 1 .7N RNE1J1
city: 5A i4J L ywof State: wpi Zip: 9`37/6
Phone:511 - Wia - 0114 Y, Fax:
Contact Person
Name: 9. A,9 -T C.14/k,4't%Q.l,ArlJ
Phone: 9411 - off i
Contractor: 0 ) R
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
Describe the scope of work in detail
N 3 to Y Zh RI6 e. (3.L4 tL J1 h ma(.=
o A site plan is provided.
o Spokane County Utilities has approved the disconnection.
o Notice of Intent # 312C.,/4 4-77-177
The permittee verifies, acknowledges and agrees by their signature that: 1) Ownership of this City of Spokane Valley
Permit inure to the property owner. 2) The signatory is the property owner or has permission to represent the property
owner in this transaction. 3) All construction is to be done in full compliance with the City of Spokane Valley
Development Code. 4) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or
local laws, codes or ordinances.
Ownership of resulting development ri•ht granted by any issued permit inure to the property owner.
Signature f %' — Date / Z- Z3 - Ug
Method of Payment:
❑ Cash ❑ Check ❑ MasterCard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 2/16/07
Y +y W
(T1 CI I )
Notice of Intent No. j Spokanelj' R
Regional
Agency Use Only I Clean Air
Refer to the Agerhy's Renovation, Demolition, and Asbestos Information Sheet
NOTICE OF INTENT
FOR ASBESTOS PROJECTS / DEMOLITION
DEC 18 2009 J
SPOKANE REGIONAL
CtitieNtukliii-AWITNeonly
A. Project Type: ❑ Asbestos Removal I ❑ Asbestos Removal & Demolition
Does this project involve a fire -damaged structure?: 'Yes ❑ No
Does this project involve demolition by fire training?: 0 Yes dNo
Flow many contiguous structures does this project involve? (5
as well as Regulation I,
Article IX
Demolition, No Asbestos Removal
(If yes, refer to Sections 9.03.F.3 and 9.08)
(See Sections 9.02.R, 9.03.F.4 & 9.04.A.6.f)
(If more than 1 structure, refer to Section 9.04.A.3)
max):
B. Property Owner:
}P>EST CFMm6eRM/»
Phone:
9tZ - 6'1 Z8
Fax:
Address:
fN
j7{l2 C /}
City:
OifecE 1/?60
State:
ital.Zip:
19276Mailing
C. Site Address:
Contact Person:
7N12 I,- *Pi
City: `/iDK4. VaU l state: r"a up:
Job Site Phone:
D. Asbestos Survey or
❑ Material Presumed
Date survey performed:
Was asbestos
found?
io t'i 2co')
AFIERA Bldg. Inspector Name:
FAR( P L. &6z&
0 Yes No
Company:
A .
Cert. No.:
-?6L1 48 II.33z`/
E. Asbestos Removal: Start
Information: Date:
List individual type and
quantity of materials to be
removed. If >1 st ucture, li4
materials for each strut re
by address / location.
Completion
Date:
Abatement By
(if known):
Total Linear Feet:
Total Square Feet:
Will all asbestos material be removed from the structure(s) by project completion? ❑ Yes ❑ No
F. Demolition
Information:
5/tart Date:
(earliest)
jP LM' -ti 82
Demolition By
(if known):
U 1+'t!D-OLoP
G. Asbestos Project and Demolitionoh kation Waiting Period and Non -Refundable Fee Categories
Your advance notification period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA.
Owner -occupied, single-family residence (sec the Renm•ation, Demo., & Asbestos info. sheet) Waiting Period Fee
Prior $0
1. 0
>_ 10 In ft and/or>_ 48 sq ft asbestos project not performed by residing owner
2. All Demolition (all asbestos must be properly removed and disposed of prior to demolition)
Waiting Period
Not owner -occupied, single-family residence
3. ❑ 10-259 In ft and/or 48-159 sq ft asbestos
3 Days
3 Days
$30
Fee
$250
4. 0 260-999 In ft and/or 160-4,999 sq ft asbestos
5. ❑ >_ 1,000 In ft and/or z 5,000 sq ft asbestos
10 Days
$500
10 Days
$1,250
10 Days
$250"
6. ❑ All Demolition
* The $250 demolition fee is waived if demolition is performed in conjunction with asbestos project category 3, 4 or 5, above.
Additional Categories Which May Apply to the Project Categories in 1-6, Above
Reference Waiting Period Non -Refundable Fee
Emergency Notification
7. 0 Emergency
Section 9.04.A.6.h
Prior Notice
Twice the Regular Fee
Select the reason that best describes your situation:
❑ Sudden, unexpected event that resulted in a public health or safety hazard.
0 The project must proceed immediately to protect equipment, ensure continuous vital utilities, or minimize property damage.
0 Asbestos -containing materials were encountered that were not identified during the asbestos survey.
0 The project must proceed to avoid imposing an unreasonable financial burden.
Reference Waiting Period Non -Refundable Fee
Alternate Asbestos Project Work Practices
8. 0 Alternate Asbestos Project Work Practices
Section 9.08.A
10 days
Twice the Regular Fee
Page 1 of 2
Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828 09/09
Exception for llazardous Conditions
9.0 Exception for Hazardous Conditions
Name of person that prepared the Alternate Work Plan:
Company he/she represents:
His/her certified AHERA Project Designer No.:
His/her Certified Industrial Hygienist (CIH) number or
Professional Engineer (PE) license number:
Demolition with Nonfriable Asbestos Rooting
10. 0 Demolition with Nonfriable Asbestos Roofing
Name of person that determined that nonfriable asbestos
roofrn_ material could be left in •lace •er Sect. 9.08.B:
Company he/she represents:
His/her certified AHERA Project Designer No.:
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):
Reference Waiting Period Non -Refundable Fee
Section 9.08.0
10 days
Regular Fee
Reference Waiting Period Non -Refundable Fee
Twice the Regular Fee
Section 9.08.6
10 days
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 1, Article I1
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 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: _
Mailing Address:
� PrintName: e R' e zT ,) - ci-i r!`ritA gbeJI
Signature: .��
Fax:
Phone:
J. Agency Use Only.
❑ NOI Deficient:
Page 2 of 2
Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / www sookanecleanair.ore / Ph:(509)477-4727 Fax: (509) 477-6828 09/09