2006, 08-21 Permit App 06003290 Demo Garage`� Permit Centel
SW
m' 11707 E Sprague Ave, Suite 106
�e Spokane Valley, WA 99206
7 (509)688-0036 FAX: (509)688-0037
Community Development wwwspokanevalley.ore
Demolition Notice of Intent
Permit Application # O(Q 1609
SITE ADDRESS: 12 50 3
ASSESSORS PARCEL NO:
E 0 e-S/,t 8T /WE7
Li S/ Sz . 1316
PERMIT NUMBER:3,9qD
PERMIT FEE: clt p �d
❑ Commercial
DU Residential
Building Owner:
Contractor: pWAW
Name: PA^JIC-(_ 6ai Q&Z 6-
Name:
Address: 1 ZSo 3 6- Pe5Nte7' 4ve'-
Address:
City: 57100/64Mr VAIAkXY State: L✓� Zip:9fZf/
City: State: Zip:
Phone: sO Q '`i Fax.
Phone: Fax:
Contractor Lic No: Exp Date:
Contact Person City Business Lic. No:
Name: 12RN I CL. (roL�(-
Phone: 7 Zn- 7 2
Describe the scope of work in detail* ***NOTICE OF INTENT REQUIRED****
peM arc 514 (W>7,/(r 1-2-K2,o 6^t24--6 C
Cost of project: $ Z Sti �915vIrg� crs r5)
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling istwill 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 leve ment rights granted by any issued permit inure to the property owner.
Signature �� ��� Date Lt G— 2! Za17 6
Method of Payment:
f Cash ❑ Check ❑ Mastercard ❑ VISA
t/Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED arZ 20U5
SCAP"N�®L�io,"s ``
�Cr r'v
Agency flse only'-
SPOKANE COUNTY AIR POLLUTION CONTROL AUTHORITY
1101 West College, Suite 403, Spokane, WA 99201
NOTICE OF INTENT
aO TO PERFORM:
e4913
ta
Alify�s�I��
A.
Project Type:
1. U Asbestos Removal
2. U Asbestos Removal & Demolition
3. Demol't' �moval
B.
Property509—
Owner: VA N l cu l /� -6L17 6fA g 1r
Phone: 9274 3 7 Z_I
MWONTROLAl1THORI
Fax:
Property Owner's121703 Ls D�,rtt� �
Mailing Address:
SP0KAA4—
Ci Vktt t P/
Mir:
State:
Zi Q92/6
C.
Site , r�
Address: I2So 3 t' DEf3Mt� /�'G
S7'o1G4
Ci
State: 111/i4
zip-1772-16
Responsible Site�� Ni �1 - ��
Contact Person:
Job Site Sag
Phone: IT Z-1 —B3 7 2-
D.
D.
Asbestos Survey or
❑ Material Presumed
If surveyperformed, was asbestos found?
❑ Yes 41ylf No, Attach Survey
Date Survey
Conducted: MA y T 05
No. of Structures:
see back if >1)
AHERA Building r
Inspector Name: �� S E7���
Certification
Number: I 0 t sl 2-7
Exp.3 -le-
�6 6
Date:U
E.
Asbestos Project
Information:
No. of Structures:
see back if >1)
Start
Date:
Completion
Date:
Wk. Days: Su M T W Th F Sa
Hours:
Total quantity
to be removed:
Ln.
Feet
Sq.
I Feet
Will all asbestos material be U Yes
I removed by project completion? ❑ No
Will work schedule CFYes
fax pgm. be used? ❑ No
List individual type and quantity of materials to _
be removed or provide an attachment of same:
Abatement
Contractor:
Phone:
Fax:
Mailing
Address:
City:
State:
I Zip:
F.
Demolition
Information:
No. of Structures:
(see back if> 1) '
Start
Date:
L1 Training Fire (List Fire Dept. as demo. contractor below)
❑ Ordered Demolition (attach copy of Order)
Demolition�y�
Contractor: o,fi o v2k Fr`u"F�� o t' ^4r)' _
Scq -
Phone: q 27 -83 i G
Fax:
Mailing 125 3 ve3M e7 h
Address:
SPO
Ci V
w
State: /j
Zi . •?9216
G.
Asbestos/Demolition Project Categories: Notification Non-Refundable
Does this project involve a fire-damaged structure? El No Waitin Period Project Fee
1. Owner-Occupied Residential Asbestos Removal & Demolition Project * Prior Notice $25
t Owner-Occupied Residential Demolition Project Only *
2. U All Other Demolitions With No Asbestos Removal Project 10 Da $150
3. IT 10 - 259 linear feet or 48 - 159 square feet see back of form for options) 3 Das $150
4. U 260 - 999 linear feet or 160 - 4,999 square feet 10 Das $300
5. 0 1,000 - 9,999 linear feet or 5,000 - 49,999 square feet 10 Da $750
6. > 10 000 linear feet or > 50,000 square feet 10 Das $1 500
7. Emer enc Asbestos Project or U Emergency Demolition Project Prior Notice Twice Project Fee
8. Alternate Means of Compliance for Friable Materials or Demolition 10 Das Twice Project Fee
9. Alternate Means of Compliance for Nonfriable Asbestos Materials 10 Da Twice Project Fee
10. Exception for Hazardous Conditions I Concurrent with Project I Regular Project Fee
* The two categories in G.1 apply only to owner-occupied, single -family residences, which means any non-multiple unit building containing living
space that is currently occupied (prior to and after renovation/demolition) by one family 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 knowl ge accurate and mplete.
�� a,at'f
9-2-1-0(
Co tep�estGv lew
S)iste
C'If;#Ilt
tf>1G :d i
Signature Representing Date
:.
Cls�thltk •{.
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. N0112105
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