2003, 06-04 Permit BD03-249 Demo.71'
DEMOLITION PERMIT APPLICATION
Permit No. g Q p3 ayc)
Address of property c(J I C &c j tt y fir
Tax lot Number
Owners Name Pc y (3 r, 0
Address / fs0()7 E Cow 7 y / v-c Phone y 0 r3
Method of destruction IOe kv7c
* Will a trash container be required on the property ? ?S yes no
* Is water available to keep the dust at a minimum ? X yes no
* Is an asphalt affidavit required ? yes no
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* Will sewer line be capped? _ yes K no OR septic tank be removed or
destroyed? yyes _ no (The Health District must be notified )
* Is there a well or sink hole on the property ? yes X no. (The Health District must
be notified if the well is to be decommissioned )
* Is there any underground flammable liquid tanks to be removed ? yes X no
(Removable of any underground flammable liquid storage tanks must be reported to the
Dept. of Ecology, PV-11, Olympia, WA 98504-8711 with a copy of this application and
set of plans) Approval from D. O. E. must be obtained before permit can be issued.
* Is there any ASBESTOS that needs removal ? X yes no (The removal of
asbestos is to be cleared by the Spokane County Air Pollution Authority )
* Police and Building Department must be notified if well is capped or filled. If not filled,
a map of the property showing the well is to be supplied to the Building Department.
* A $500. cash deposit or surety bond is supplied for cleanup. yes no
Building Permit Fee $35 for SFR + + $20. Gar.
$70 for Com. + costs of other permits
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Owner or agents name
Date
Received by Building Department Date
Routed to: Planning / Zoning Water / Sewer Health
Date Police Agency Fire Dept. Pollution
Cash deposit: yes no OR bond yes no
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