2012, 05-08 Permit App: EGR-2012-0011 Property GradingCommunity Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
permitcenter(a sookanevaliev.orq
(Staff Use Only)
PERMIT No.:
CHECKLIST: DY ❑N INrr:
LAND DISTURBANCE PERMIT APPLICATION
STAFF USE :
0 ENGINEERED GRADING
0 REGULAR GRADING
0 GRUBBING & CLEARING
APPLICANT USE : c� ry�
SITE ADDRESS: 7175 5 tie i tAkz/''
ASSESSORS PARCEL NO.: 4-,r5- t 3 Z I r)
Aye,
APPLICANT NAME: 3 {i L) ce
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PHONE: ...50C( 96t
553Gi
EMAIL:
CONTACT NAME (❑ SAME AS APPLICANT) :
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(.I -ea/0C) Sr,JiP;
PHONE: Z62 tr,SS /7d EMAIL: IN eits t eefS�� AKI,41. it , Cot-t„CELL:
PROPERTY OWNER NAME: ..
MAILING ADDRESS: -79/ 5 k, Sna%1 L (, ktOc:( -
CITY: Ok_aie Vette STATE: AM--
PHONE:
t% -PHONE: q QC( S 3 EMAIL: ke trqs,r (.tce t
CONTRACTOR NAME: (LETBD):
%6/5...4rAeer4 PLLC)
.'/' 00J/ter
ze) 7-515-7/7747
Vsk ECK IF APPLICANT
CELL:
ZIP: 9Q Zt Z
0 CHECK IF APPLICANT
MAILING ADDRESS:
CITY: STATE:
ZIP:
PHONE: EMAIL: C4LL:
STATE LIC. NO.: EXPIRES: u�h
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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/L7Pt1^ o f'efrS2 fa t -a 6 e e.ee a6ovre
ESTIMATED QUANTITIES (CUBIC YD): CUT:
IF CUT, PROVIDE DESTINATION OF SOIL:
START DATE: 4//4(A Z ulee(c�
%3�Ia'/`LeG e / . /do lw.yolt .A/c. f)64+ 'S Sit
S'�� 3 FILL: 5ezn )
See a4v/e_
ESTIMATED COMPLETION DATE: Ai( l -k i & 3 Kko O (? _s41+
/ /20
Updated March 2011
\\SV-FS2\Public Foiders\Communiity Development\02 Administration\03 Forms - Official Versions\Permit Center\Land Disturbance Permit & Checldist 3-
29-11.doc
Spo'kane
.00.1;VaBey
LAND DISTURBANCE (LD) PERMIT CHECKLIST
For Grading, Clearing and Grubbing work outside the Right -of -Way (ROM
(For work within ROW need a ROW permit)
Permit Center ♦ 11703 E Sprague Ave Suite B-3 ♦ Spokane Valley WA 99206
509.688.0197 ♦ Fax: 509.688.0037 ♦ permitcenter@spokanevaltey.org
Project Address: -6:7/,_5 , S, / --k (�, ✓e s,, � V- Today's Date: .s--1-- J 'Z
Project Descriptio :,, j ret, -)1 ,�� f re,,
Signature: ,a _ Print Name:,17,1,k& . S , Ff (Wks E iAPefs Par)
The purpose of this checklist is t• gather information about the proposed project so to determine what land
disturbance permit, if any, is required by the Spokane Valley Municipal Code.
Starting with Part 1 and working from top to bottom, please answer the following questions.
The first "Yes" identifies the type of land disturbance (LD) permit required.
PART 1 — Is LD work exempted or already covered? (SVMC 24.50.020) If so then LD permit not needed.
0 Yes 0 No Does your project only have to do with emergency utility work; cemetery graves; eliminating
septic tanks; digging out a basement; building a wall less than 4 feet high; disposal of refuse
that is covered under other regulations; already permitted mining, quarrying, stockpiling of
aggregate material (rock, sand, gravel, aggregate, or clay) or exploratory excavations done
under the direction of a licensed engineer or engineering geologists? If yes`, then project
exempted from a LD permit.
PART 2. Engineered Grading Permit needed? (SVMC 24.50.030: 2 sets plans, calcs etc. from Engineer)
❑ Yes 0 No Will this grading be for a short plat, subdivision or binding site plan?
❑ Yes 0 No Will any grading occur in a FEMA floodplain, wetland, wetland buffer, Fish and Wildlife
habitat conservation area or geologically hazardous area?
❑ Yes 0 No Will the volume of excavation or fill for the project be over 500 cubic yards? (If checked Yes
then a SEPA environmental checklist will need to be submitted for review)
❑ Yes 0 No Will the grading create a base or support for a permanent structure?
❑ Yes 0 No Will the grading be for a driveway that is longer than 75 feet?
❑ Yes ❑ No Will any grading occur in a drainage channel or be for a water feature (like a perennial or
intermittent pond) with a surface area greater than 500 square feet?
❑ Yes 0 No Will this grading result in the addition or replacement (excluding pavement maintenance) of
5,000 square feet or more of impervious surfaces or the disturbance of 1 acre or more land
or the construction of new drywells or other underground injection control (UIC) facilities?
0 Yes 0 No Will any excavations or fills have slopes at 2:1 (H:V) or steeper and heights greater than 2
feet?
❑ Yes 0 No Will any excavations or fills have slopes at 10:1 (H:V) or steeper and heights greater than 4
feet?
PART 3 — Regular Grading Permit needed? (SVMC 24.50.040; 1 set of plans showing grading and
temporary erosion and sediment control; does not require engineering)
0 Yes 0 No Will the volume of excavation or fill be over 50 cubic yards on any one lot?
0 Yes 0 No Will any excavations have slopes at 2:1 (H:V) or steeper or heights greater than 3 feet?
0 Yes 0 No Will any fills have slopes at 2:1 (H:V) or steeper or heights greater than 2 feet?
PART 4 — Grubbing and Clearing (G&C) Permit needed? (SVMC 24.60.050: 1 set of plans showing G&C
and temporary erosion and sediment control; does not require engineering)
0 Yes 0 No Will the G&C work disturb 5,000 or more square feet of area or remove 7 or more trees?
(Note that forest practices overseen by DNR or commercial agriculture are exempt)
0 Yes 0 No Will there be any clearing on slopes or near/in FEMA floodplains, wetlands, wetland buffers,
Fish and Wildlife habitat conservation areas, geologically hazardous areas or erodible soils?
If the answers to all of the questions above are "No" then a permit is not required for the proposed work.
*Wane
Valleyt
Development Engineering
11707 E Sprague Ave Suite 106 • Spokane Valley WA 99206
509.921.1000 ♦ Fax: 509.921.1008 ♦ cityhall@spokanevalley.org
Letter of Transmittal
Date: August 30, 2012
To: CSV — Permit Center
From: Henry Allen
CSV - Development Engineering
RE: Project: Riverway E South 7915 - EGR-2012-0011 — Weyrauch Residence
We are sending to you -
® Attached ❑ Under separate cover via: the following:
ITEM #
COPIES
DESCRIPTION
1
1
Set of approved Civil plans for the subject project.
2
3
4
These are sent for the purpose(s) checked below:
n For approval
M For your use
n As requested
['For review and comment
❑ Other
Comments:
Civil Plans to be issued with Grading Permit.
n Approved as submitted
❑ Approved as noted
n Returned for corrections
❑ Confidential
cc: Spokane Valley Development Engineering — Project File
Weyrauch - EGR-2012-0011 - Plans to P Ctr.docx