2006, 08-17 Permit App: 06003251 Salvage Materials MHSpokane
�.'�Valley
Community Development
Permit Center
11707 E Sprague Ave,
Spokane Valley, WA
(509)688-0036 FAX:
www.s.okanevalle .o
Demolition
Permit Application
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me 106p,UG 1 2
688-0037
UUP oD�"�
PERMIT NUMBER: �aS k
PERMIT FEE: A-14.tr-)
Notice of Intent n Commercial
# O (p- (: $ 9 ❑C Residential
SITE ADDRESS: / 7�/ a ` �� f rk 44' 4/�L�
ASSESSORS PARCEL NO:
Building Owner:
Name:( f_ LI
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Name:
Address: 17a ?is, _ ,c, 4/ nii-t
City:s t O,r✓f-Fyvr t /4l, State: 79
Zip: y jdl/
�v
Phone: Swl g„6 fr-75_5 3 Fax:
City:
Contact Person
Name:
Phone:
Contractor:
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
Describe tjae scope of work/i'n detail**' * *NO ICE OF IN1 ENTI QUIRED* * * * p
S A 2/ 4ic lY g / ,-) A -4 e �1
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Cost of project: $
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) This 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 be submitted, and subsequently approved before this application can be
processed.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signatures-';� ��
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
REVISED 8/23/2005
❑ Check
Date g-,'7-vO
❑ Mastercard ❑ VISA
Expires: VIN#:
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SPOKANE COUNTY AIR POLLUTION CONTROL AUTHORITY
1101 West College, Suite 403, Spokane, WA 99201
NOTICE OF INTENT
i _OI) TO PERFORM:
ki
ti
Agency
t
use only
A. Project Type:
1. U Asbestos Removal
2. Asbestos Removal & Demolition
3. U Demolition, No Asbestos
Removal I
B. PropertyS
Owner: r'j 67/C7{.2, / c
2' S
Phone:S 9-/n- 3
(If available)
Fax:
Property Owner's
Mailing Address: /7,7/e. p v C
City: SA 4,.•. 4,4
State: 4---- /Z .
Zip: SS.O/4
C. Site _ /1/4
Address: / 7,2/ Y �= r/ /9 „i
// /
City:$2v,& ., i�4
State: L,h(
Zip: f ldl�a
Responsible Site
Contact Person: 6-» c y /- / ', WL
f
Job Site a ' S
Phone: i-(,
i -/ 6-3—s
D. U Asbestos Survey or
❑ Material Presumed
If survey_performed, was asbestos found?
IS Yes U If No, Attach Survey
Date Survey " _
Conducted:tI VV
No. of Structures:
(see back if>1
I
AHERA Building /'
Inspector Name: j ♦�vI �r (��
Certification 11111l 1�y�
Number: Oa %
Exp. �/
Date: 2 I' I
E. Asbestos Project
Information:
No. of Structures:
(see back if> ) [
Start
Date: '6119/D-
Completion
Date: �l afl (n
Wk. Days: Su
Hours: y
M T W Th F Sa
Total quantity
to be removed:
Ln.
Feet
?
,t / /
Sq.
Feet
Will all asbestos material be Yes
removed by pr• ject completion? ❑ No
Will work schedule
fax pgm. be used?
U Yes
❑ No
List individual type and quantity of materials to
g gp -'- , '' ALA 1�, a a J'
Sprjn�
be removed or provide an attachment of same:
q t p n * :, ,i ts,
Abatement �J�1�,
Contractor: �/ �%e()�Q� Oii�P� lj' +
Phone:
Fax:
s , �,,/
Address:
Address:1 �r GjC/1 NtL01
U
Qdj(City;
State:
Zip:
F. Demolition
Information:
No. of Structures:
(see back if> 1)
StartU
Date: c,. Oaf UV'
Training Fire (List Fire Dept. as demo. contractor below)
0 Ordered Demolition (attach copy of Order)
Demolition c ---7V I mt)n�� ?kLP
Contractor: r t (j p
Phone:
Fax:
Mailing
Address:
City:
State:
Zip:
G. Asbestos/Demolition Project Categories:
Does s project involve a fire -damaged structure? ® Yes 0 No
Notification
Waiting Period
Non -Refundable
Project Fee
1. Owner -Occupied Residential Asbestos Removal & Demolition Project *
0 Owner -Occupied Residential Demolition Project Only *
Prior No 'c
1
C_____$25_
2. U All Other Demolitions With No Asbestos Removal Project
10 Days
$150
3. U 10 - 259 linear feet or 48 - 159 square feet (see back of form for options)
3 Days
$150
4. U 260 - 999 linear feet or 160 - 4,999 square feet
10 Days
$300
5.1J 1,000 - 9,999 linear feet or 5,000 - 49,999 square feet
10 Days
$750
6. 0 > 10,000 linear feet or> 50,000 sqquare feet
10 Days
$1,500
7. U Emergency Asbestos Project or U Emergency Demolition Project
Prior Notice
Twice Project Fee
8. ❑ Alternate Means of Compliance for Friable Materials or ❑ Demolition
10 Days
Twice Project Fee
9. U Alternate Means of Compliance for Nonfriable Asbestos Materials
10 Days
Twice Project Fee
10. U Exception for Hazardous Conditions
Concurrent with Project
Regular Project Fee
* The two categories in 6.1 apply only to owner -occupied, single-family residences, which means any non -multiple un t building containing living
space that is currently occupied (prior to and after renovation/demolition) by one fam'ly who owns the property as their domicile. One of the
categories in G.2-9 must be used for all other renovation/demolition projects. For more information, contact SCAPCA at (509) 477-4727.
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):
I. I certify that the information contained in this notification and any supplemental data provided is, to the best
of my owledge, ac •• . . d complete.
Jfr
' 9. j ,05
• 1 i°Q
-/717-re �
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1aiO`
Signature Representing Date1�
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Your advance notification period will begin when a completed NOI, including required fees, is received by SCAPCA.
A copy of the asbestos survey, completed notification & all amendments must be available for inspection at all times at the job site. NOI12/05