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2010, 04-23 Permit App 10001138 Demo GarageCommunity Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 permitcenterCalsookanevalley. orq (Staff Use Only) PERMIT NUMBER: PERMIT FEE: DEMOLITION PERMIT APPLICATION / Or f l •fig PROJECT ADDRESS: -3-a 2 2 N. Co1ev>,Ct_I• R) S p oKake uitfleY l t' )4 9 c12. 17 ASSESSORS PARCEL NO.: 7 S 0 pie 0 BUILDING OWNER NAME: Sif, et IA, 0 1<1 V ett- MAILING ADDRESS: 2 TV C t- le vtn cu fl J CITY: S Ka h e. Vek f I S y STATE: Lo AZIP: c, `a 1 CONTACT PERSON NAME: kc. LLB N ID i4 i v e if PHONE(goZ) l) - 6g GO FAX: rr CELL: (5Di: ��2-q 0 CONTRACTOR NAME: 4 cis, sr, AS D P In t) I t 't! (, Ui MAILING ADDRESS:: p o, 3 X' y 5 3 5- CITY: S p Kayt. 'e STATE: ZIP: /p c/2[g D O 5 7 c PHONE: C.) 535 - 77 4% j-y FAX:(5o9) 53c:- P, L B 7 CELL( 07) IIq L(— 3Sct5 CONTRACTOR LICENSE No.: L._ r 'R 5 0 O OXPIRES: CITY BUSINESS LICENSE NO.: PROJECT DESCRIPTION (Please Provide Site Sketch) Site Plan Provided ❑ Notice of Intent # El Spokane County Utilities has approved the disconnection Describe the scope of work in detail e o << S k v ,4 w c y y r a.cl S (c 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 be submitted and subsequently approved before this application can be processed. Signature ,r. 76)Date: y 1 3 / 1 0 Method of payment: ❑ Cash 0 Check ❑Visa 0 Mastercard Bankcard #: EXP: VIN#: Authorized Signature: Effective October 28, 2007 P:\Community Development\Forms\Building forms\Demolition Permit App.l.doc Page 1 of 1 10-00 Notice of Intent No. I, Spokane % la Regionalp i�r Agency Use Only k Clean HlrAgency NOTICE OF INTENT FOR ASBESTOS PROJECTS/DEMOLITION L2cIsr`'7f` i; APR 232010 SPOKANE REGIONAL CLE' N NiR •GENn c •i4: LJ Refer to the Agency's Renovation, Demolition, and Asbestos Information Sheet as well as Regulation I, Article DC A. Project Type: E Asbestos Removal _ Asbestos Removal & Demolition E Demolition, No Asbestos Removal Does this project involve a fire -damaged structure?: • Yes is.No (If yes, refer to Sections 9.03.F.3 and 9.08) Does this project involve demolition by fire framing?: ■ Yes ® No (See Sections 9.02.R, 9.03.F.4 & 9.04A.6.f) ' How many contiguous structures does this project involve? (5 max): / / (If more than 1 structure, refer to Section 9.04.A.3) B. Property Owner: ' f //IVCff Phone:SO?- 22-4BBD Fax: Mailing Address: .3Z `„�'� we Die Fx a a R tit City: ew t lip ((o-Y State: juP Zip: Q R,2 a_C. Site Address: 32Q2NCn/eMe, v.Rd City: Issea, eVal%y Is State: tbP Zip: Ica i2. Contact Person: 9 in a N, & fl 1 o if eY Job Site Phone6b7 V2 Wit D. 3 ❑ Asbestos Survey or Material Presumed Date survey performed. `-1/ ) f, f / a AHERA Bldg. Inspector Name: f q PIS 4 h Bc k e, n , Was asbestos found? ❑ Yes .1 No Company: nark %ld/ JJ �bc'C)C Cert. No.: t0- ©Y/i E. Asbestos Removal Information: Start Date: Completion Date: Abatement By (ifknown): . List individual type and quantity of materials o be removed. If>1 structure, list materials for each structure by address / location. Total Linear Feet: Total Square Feet: Will all asbestos material be removed from the structure(s) by project completion? n Yes n No F. Demolition Information: Start Date: (earliest) A ._ 0ya Demolition By (if known): I, o. r 5 fr...i,q� ) c. i+'_O I / -fit 0 h G. Asbestos Project and Demolition Notification 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 (see the Renovation, Demo., & Asbestos info. sheet) 1. 0 >_ 10 In ft and/or 2 48 sq ft asbestos project not performed by residing owner Waiting Period Prior Notice Fee $0 2.1e 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 3. ❑ 10-259 In ft and/or 48-159 sq ft asbestos 3 Days $250 4. 0 260-999 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 10 Days $1,250 6. ■ All Demolition 10 Days $250* * 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 Emergency Notification Reference Waiting Period Non -Refundable Fee 7. 0 Emergency Section 9.04A.6.h Prior Notice Twice the Regular Fee Select the reason that best describes your situation: 0 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. ❑ Asbestos -containing materials were encountered that were not identified during the asbestos survey. ❑ The project must proceed to avoid imposing an unreasonable financial burden. Alternate Asbestos Project Work Practices 8. 0 Alternate Asbestos Project Work Practices Reference Waiting Period Non -Refundable Fee 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 Hazardous Conditions 9. ❑ Exception for Hazardous Conditions Reference Waiting Period Non -Refundable Fee Section 9.08.0 10 days Regular Fee 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 'tvith 1'qonfriable Asbestos Roofing 10. 0 Demolition with Nonfriable Asbestos Roofing Reference Waiting Period Non -Refundable Fee Section 9.08.B 10 days Twice the Regular Fee Name of person that determined that nonfriable asbestos roofing material could be left in place per Sect. 9.08.B: Company he/she represents: His/her certified AHERA Project Designer No.: H. Optional: List additional parties you would hire copies of this NOI and/or related notices sent to (list name & fax number and/or mailing address): I. Acknowledgement Officer, following: the complete. or duly authorized representative, shall be allowed control, recovery, or release of contaminants into the For the purposes of renovation, demolition, when renovation, demolition, or asbestos Officer or duly authorized representative are investigating that air quality violations have occurred or may be information contained in this notification and any to access property at reasonable times to inspect projects atmosphere, in accordance with SRCAA Regulation I, Article II and asbestos projects, reasonable times include, but are not limited removal appear to be occurring or are scheduled to occur, and times air quality complaints filed with agency and/or have occurring. No person shall obstruct, hamper or interfere with any The Control specific to the and RCW 70.94.200. to, any of the when the Control reason to believe such inspection. I certify that accurate and Business Name: MailingAddres: Signature: supplemental information provided is, to the best of my knowledge, - Fax: Phone/sibyl 122 -9 880 \ / /� fV„3,2<2Z CA! r.pty. Rd spoka,ketj%ii�, L,W 79J2O. l Name: S L CLW Af D i< ((I eft D r)—� Print J. Agency Use Only. 0 NOI Deficient: 'SINOI Complete =- `3//a a & Initial Page 2 of 2 Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.ore / Ph:(509)477-4727 Fax: (509) 477-6828 09/09 �:J „lic) jQ ve