Dishman S 227 Chuck Little
.
.
(THIS tS NOT A PERMlT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTANO
COMPLETE IN INK
(Please relurn Ihis original and your building plans to the Oeparlmenl o( Building artd Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE ~
~ Projeci NumDo
OwrtPr s Name LAST FIRS7 MI
17 L
Prorecf AdQress (Strest Name 8 NumperI ZID
eel uTy 227 r)isi~D
AppliWnt Address
?c6 Le~ ~ -3 -7006 4e
Clly Stale ZIP Phone
I '
eusmess Mone
Contractor/ApBnt kO 1i ~.~J • S Address
GIty scaie zip Phone
~ CAJA /Z 1 ~ 7
CoM Ltcense Number (Required) 8usiness Phone
l 1
Lr Po cA4 14~ C~
aahiteclrEngmeer Aaaress
City 3tate ZIp Phone
l I
Gmtact Bus+ness Phona
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Lenaer AOdress
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DEPARTMENTAL REVtEW
Cond - '
Appraved Approval Hold
~
Environmental Heellh Permit Number
~
~ W 1101 Col'lege '
Rpom 200
-
, • .
~ ~Plenning/Zoning
~ N 721 Jefferson
,
doopw
~ - - -
Engineers Permit Number
N 811 Jetferson'
.
Utiltlies
❑ N 811 Jef terson -
. ~ Plen Revtew/Flre Preventfon
N 811tJetferson
-
Other (SEPA/Critlcat Meterlaf/etc I '
❑ '
i
C] Fest Track/Speciel Inspectlon Informetlon _ i
Project Aepresentative 't Phone
Ad0►es&
1 certiiy that 1 have examined this applicatlan and state that, the inbrmahon cvntafned in 'jt and submitted
by me or my agent is true. correct, tegei, and binding
r
Owner s Srgnature ' _ Dale
. , . 4
DEPI4RTN1 L N1'AL R EV1 E1Af Coirtd
Approwed Approval M
Envlrclnmental Heallh Rermrt tVumber
1l1! 1101 College
Rtaam 200 '
4
~'O"R1BnnJng/Zor,lng
M 721 Jef ferstm
~
~ ~J 0 J' ~ ~ -
~
~ Engtr~eers Fermit N+umber
~ N 811 Jeifsrson
Utililies
N. 8t t Jeiterson
, . ~
Plan RevfewlFlre Preventfion
id N 817 .leffSrspn -
Other (SEPAICrilfcel N!$teriatJotc ~
~
Q Fast TrackiSpeclal Inspection Inforniatlan
~t -
Pr4t+~t ReRresentative PMone
AQdress
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1 Cetiify that I fisve exarnirred Ihis aGpt#Catian afid stale tilai !he tnformaki0n canlairied in it and subrnitted
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Gontact Pereon Name BuBiness Name Chu.,CA L~Jtle
Addreas Qddreas--5. L,N-Sh,,,17f[l.tI
Phoae Phone TZ7- Q(o-55
County Coatact Pereoa Phone No. 456-3600 Date /Q - -
COIMIlMERCIAL BUILDING PERMIT REVIEW
Thie building permit review is intended to appraise you of the improvemente (coedway, side-
walk, curb, atormwater, etc.) which must be constructed in association wieh your building
permit. This checklist will be filled out by the Engineer's staff and a copy will be re-
turned to you at the time that the pecmit is ini[ialed by the Lngineering Department. All
requicements shall be completed prior to iseuance of [he building permit. All unchecked
boxea require additional research or infocmation to make a determinatioa.
1. Stormwater Draina e Consideratione
I~er gueT~neor '3tormwater Menagement 1981" both on and off eite.
.
1. 208 Considerations* J(~ lAo'ki~ Yes tj No
~
r
2. Flood hezard zone considerations** ~ Yes No
3. Storm Draiaage Plan Yes ~ No
II. Planning Action 0
We vo la short plat, rezoae, Conditional Dse or Variance Yee No
'►~1~1. 1~
~ % on property. Planniag Number Z~1 _V
Fi I~'_ ZZIP
2. Are requiremente of planning action incorporated ~ Yes WNo
into site plan
III. Mffht of Way
1. Does permit neceeaitate R.O.W. dedication a Yes No
2. Did zone change require R.O.W. dedication a Yes No
3. Radiue at coraer ~ Yes No
IV. County Road Improvementa
1. Roads need to be improved. How wide p Yes t~ No
2. Curb ~ Yes ~ No
3. CRP/RID agreement (Copy of deed, contract, or ~ Yes ~ No
ti tle report requi ced
4. Plane for improvemente provided ~ Yes No
5. Sidewalk ~ Yes ~ No
V. Parking Plan b Approach Locetion
1. Review and ei ga of f by Traf f i c es a No
2. Approach Permit from Engineer'a Office VYes ~ No
3. State or GY ty eign off ti Yes No
4. IB thi s road oA 6 Yea r Plan Li Yes ~ No
VI. ULID Agreement: El Yes q No
VII. Field Review: Preliminary Comments
* Al l land withi n the Aqui Eer Sensi tive Area, where deemed feasible by the County Engi-
neer, shall inco rporate stormwater tceatment to mitfgate the potentiai for groundwater
degradation. (See Guidelinea Eor Stocmwater Management 1981, Spokane Board of County
Commissioner'e Re$olutton No. $0-1592, as amended.)
1`he purpose of f locid hazard zone review is to minimi ze losses due [o f looding in spe-
clfic sreas designated hy Flaod Nazard Bocindary maps on file a[ the County Engineer's
Office. (See Spokene Board of CounCy Commissioiiec's Resolution No. 81-0726, as
amendPd.)
8/22/KS