2009, 04-01 Permit App: 09000803 Demo Garage Permit Center C-‘(-
Sary or'kane 11703 E Sprague Ave,Suite B-3
PERMIT NUMBER:
poSpokane Valley,WA 99206 �� PERMIT FEE:
do•f Valley. (509)688-0036 FAX: (509)688-0037
www.spokanevalley.org `
Community Development
Demolition Commercial
Permit Application Residential
SITE ADDRESS: /.. / 7 3 . I 7( c"'- LI ', L 0
ASSESSORS PARCEL NO: R` ---' T Z L \.Z
Building Owner: Contractor:
Name: GO r i/' .. . 0, s r Name:54-r,r j;,r✓ r z i
Address: /I
`7 e 6 :G d ip t' Address: i I 5 G ` fti c7
City: State:lj,4 Zips 5-, ' City: c.,�`_` State: c,i 4 Zipr�(Z`
� U� I.,.e' e�
Pho �, Fax: Pho e:�� c F
s-�� -iib s� � ��j� i 2/6 Pho e � ,D , 7fc, `sP,; =1/3- /���
Contractor Lic No: Exp Date: -
Contact Person City Business Lic.No:
Name: ,j/ d-c-n-' _
Phone: 5'D�j� 93' - 7/O 5j
Describe the scope of work in detail
l ecti c d0 ;,..) ,1 41 S '71et G( 9 4 - c't y `-(
o A site plan is provided.
o Spokane County Utilities has approved the disconnection.
o Notice of Intent #
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 rights granted by any issued permit inure to the property owner.
Signature //_ `•-� -�-" Date 4/ / - C%
Method of Payment:
❑ Cash ❑ Check ❑ MasterCard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 2/16/07
Mar. 24. 2009 1 : 38PM SPOKANE CLEAN AIK NO. 0/,iv r._ I
115—C . •l 1
10_71-07/04...:4.-...,. NOTICE OF INTENT MAR 24 2009
• Notice of Intent No. Spokane4 t;t .
RecienaItit • FOR.ASBESTOS PROW Et:I s/DEMOLITION
l Agency Use Onry Clean AirAg, _Dote.L.. 1}10,y - 4! -----
Refer to the Agency's Renovation,Demolition,and Asbestos Information Sheet as well as 'egn at on , • r le e • '
A. Project Type: ❑Asbestos Removal 17 Asbestos Removal&Demolition Demolition,No Asbestos Removal
Does this project involve a fire-damaged structure?: ❑Yes li o (If yes,refer to Sections 9.03.P.3 and 9.08)
Does this project involve demolition by fire training?: D Yes (ago (Sec Sections 9.02.R,9.03.F.4&9.04.A.6.f) -
How many structures does this project involve?: ( (If more than 1 structure,refer to Section 9.04.A.3)
Nomminommima
B. Property Owner: Q; %. �,-- Phon 9y,,_7/05S Fax; -
Mailing Address; 119 O to ,6 a, , 4,e City: k..._c.. State:vt)A Zip: 59 L--0.f.
C. Site Address: /X/ 7 Si F jJ City:49,)c,^.,c, State: 04 Zipg92U c
Contact Person: t// 5'.L.,. _ Job Site Phone m.)937-7/05—
D. ,Asbestos Survey or Date survey perforrned;$-2.0-0 AHERA Bldg.Inspector Name: , »___-i.-- �'� E S
0 Material Presumed Was asbestos found?0 Yes. o Company: 59eZ...( ,6nr,', Cert.No.: ... O g- d 8'-0=3 'od
E. Asbestos Removal Start Completion Abatement By
Information: Date: Date: if known : •
List individual type and
quantity of materials to be
removed. If>1 structure,list
materials for each structure _ Total Square Feet: Total Linear Feet:
by address/location. Will all asbestos material be removed from the structure(s)by project completion?❑Yes 17 No
F. Demolition Start Date: Demolition By
Information: (earliest) . r;( .2..0244 (if known): �1a p �i�i'4 _„
G. Asbestos Project and Demolition Notification Waiting Period and Non-Refundable Fee Categories
Owner-occupied,single-family residence(see the Renovation,Demo.. &Asbestos info.sheet) Wallinb Period Fee
1.0 All Demolition(all asbestos must be properly removed and disposed of prior to demolition) 3 Days $30
Not owner-occupied,single-family residence Waiting Period Fee
2. 0 10-259 In ft and/or 48-159 sq ft asbestos 3 Days $250
3.❑ 260-999 In ft and/or 160-4,999 sq ft asbestos 10 Days $500
4.❑ 2 1,000 In ft and/or?,5,000 sq ft asbestos 10 Days $1,250
5.Xi ' 11 Demolition '10 Days $250*
Additional categories
❑ I have completed and attached the Supplemental Notice of Intent(NOP for emergency,alternate asbestos project work practices,
demolition with nonfriable asbestos roofing,or exception for hazardous conditions.
* The$250 demolition fee is waived if demolition is perfortned in conjunction with asbestos project category.2, 3 or 4, above.
it Optional:List additional parties you would like copies of this NOT and/or related notices sent to(list name&fax number and/or mailing address):
L I certify that the information contained in this notification and any supplemental information provided is,to the Co leteness Review
best of my knowledge, accurate and complete. C NOT complete
❑ NOI deficient-
Business Name: iii a 'r ! QV-P "Fax: one: — See Attached
i
MailingA%d -es:. I d
. . /1 J ,—
Si n` ��/�- � '- Print Name: Agency Use Only ,
•
n
legeSuite 403 SpokaneWA 99201 /vwvw.spokanecleanair.ot•g/Ph.:(509)477-4727 Fax:(509)477�68�8
Q�
Spokane Clean Air, 1101 W.Col g , P ,
Your advance notification period will begin when a completed NO!,including required nonrefundable fees, is received by SRCAA.NOl 11/05
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1 inch = 50 ft.