2010, 08-23 Permit App 10002591 Demo GarageS iikane
Valley.
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www. spokanevall ev. org
Demolition
Permit Application
PERMIT NUMBER:
PERMIT FEE: 21
ri Commercial
n Residential
SITE ADDRESS: [ 3 7, 3,
ASSESSORS PARCEL NO:
A '
Lr Ii7 tv, yg2/6
Building Owner: tNtir
�-ee,7-t�iL G, A):,
) C..,z ( L .
Name: Av'eA. 4/
Address: 14
3
3 �' • g%ZoA .„( ,
City:sPn i
�� ;lei State: ` ti Zip: �Z J f
4'
Phone:
Sb,
Fax:
'q 3 2 7c ATAA
Contact Person
Name: K�,C, A erR,11
Phone: g3 2 70 ;—
Describe the scope of work in detail
Contractor:
OCe.,
'0
Name:
Address: <
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
-
os 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 V,i2,
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
REVISED 2/16/07
O r Q2
❑ Check
Date8/2 3/Jo
❑ MasterCard ❑ VISA
Expires: VIN#:
Notice of Intent No. Spokane%/'
4
Agency Use Only Clea naAi rAgenry
NOTICE OF INTENT
FOR ASBESTOS PROJECTS / DEMOLITION
Date Stamp - Agency Use Only •
Refer to the Agency's Renovation, Demolition, and Asbestos Information Sheet as well as Regulation I, Article IX
A. Project Type:
❑ Asbestos Removal
Asbestos Removal & Demolition
51 Demolition, No Asbestos Removal
Does this project involve a fire -damaged structure?:
Does this project involve demolition by fire training?:
How many contiguous structures does this project involve? (5
max):
❑Yes N
❑ Yes No
(If yes, refer to Sections 9.03.F.3 and 9.08)
(See Sections 9.02.R, 9.03.F.4 & 9.04.A.6.f)
(If more than 1 structure, refer to Section 9.04.A.3)
B.
Property Owner:
Ke,)1° ay 6., 4a>,L Ch.+,' L ;lalhone:
S� €q3 2-I^,
ax:
Mailing Address:
.Socket A P tiAltert
State:
IVA
Zip:
`'J' 2,6
b I/37 3 s. PRe a A t.,,&.-, A u e City:
C.
Site Address:
I
i 4323 G', B/Ppa f el Ants! au A+�P
City:
j fr r (I p
State: vA Zip: 92/6
Contact Person:
,, A0 ray,/e
Job Site Phone: 813 - 27ts
D. g Asbestos Survey or
❑ Material Presumed
Date survey performed:
Was asbestos
found?
❑ YesJNo
AHERA Bldg. Inspector Name:
Company:
ic;cw }1
Le4Ry
Cert. No.:
;30P, i0 —c07-3
E. Asbestos Removal
Information:
Start
Date:
List individual type and
quantity of materials o be
removed. If>1 structure, list
materials for each structure
by address / location.
Completion
Date:
Abatement By
(if known):
Total Linear Feet:
Total Square Feet:
Will all asbestos material be removed from the structure(s) by project completion? P 1 Yes n No
F. Demolition
Information:
Start Date:
(earliest)
dEn
?o,�y
Demolition By
(if known):
p
It/e» A o2612!G/
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. ❑ Z 10 In ft and/or >_ 48 sq ft asbestos project not performed by residing owner
Waiting Period Fee
Prior Notice
$0
2. All Demolition (all asbestos must be properly removed and disposed of prior to demolition)
Not owner -occupied, single-family residence
3. 0 10-259 1n ft and/or 48-159 sq ft asbestos
3 Days
Waiting Period
3 Days
$30
Fee
$250
4. ❑ 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. 0 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 9.04.A.6.h
Prior Notice
Twice the Regular Fee
Select the reason that best describes your situation:
El Sudden, unexpected event that resulted in a public health or safety hazard.
El The project must proceed immediately to protect equipment, ensure continuous vital utilities, or minimize property damage.
0 Asbestos -containing materials were encountered that were not identified during the asbestos survey.
El The project must proceed to avoid imposing an unreasonable financial burden.
.Alternate Asbestos Project Work Practices Reference Waiting Period Non -Refundable Fee
8. ❑ Alternate Asbestos Project Work Practices
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
ption for Hazardous Conditions
. ❑ 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 with Nonfriable Asbestos Roofing
10. ❑ 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 like copies of this NOI and/or related notices sent to (list name & fax number and/or mailing address):
I.
Acknowledgement
The Control Officer, or duly authorized representative, shall be allowed to access property at reasonable times to inspect projects
specific to the control, recovery, or release of contaminants into the atmosphere, in accordance with SRCAA Regulation I, Article II
and RCW 70.94.200. For the purposes of renovation, demolition, and asbestos projects, reasonable times include, but are not Limited
to, any of the following: when renovation, demolition, or asbestos removal appear to be occurring or are scheduled to occur, and times
when the Control Officer or duly authorized representative are investigating air quality complaints filed with agency and/or have
reason to believe that air quality violations have occurred or may be occurring. No person shall obstruct, hamper or interfere with any
such inspection.
I certify that the information contained in this notification and any supplemental information provided is, to the best of my knowledge,
accurate and complete.
Business Name: if' A Fax: ---- Phone: er( 3 — 2 7G5
Mailing Address: 14 3 2 3 C. P &e,,4 lb, A- y A if e
//
Signature:_^ (gam-P•-�Jr% Print N lame: 14» A U-eiz. `/
J.
Agency Use Only.
❑ NOI Deficient:
0 NOI Complete
Date & Initial
Page 2 of 2
Spokane Clean Air, 3104 E. Augusta Ave., Spokane, WA 99207 / wtiwv.spokanecleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828 09/09
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