Sprague E 11618 Skipper's Inc
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(fHiS !S NOT A PERMIT) Caulo~
6UILDING PERMIT APPLICATIDN WORKSHEET
~ PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
COMPLe(E IN INK
; (Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR OEPARTMENTAL USE
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DEPARTMEMTAL REVIEW
Approved Cand. Hold
* Approval
Envlronmental Hsalth Applicatlon N
W. 1101 Colleye
Room 200 ,
r Plannlng/Zoninq .
N. 721 Jefferoon
Engi~ Y, Zz
N. 811 Jefferson
UNtItlN
❑ N. 811 Jaffaroon
lan ~ Fin Prw~tlon I I
N. 811 Jefferoon
~ OtMr (SEPA/Crltlcal Mabrlal/ete.)
❑
C] Fat Traek/SpKlal Inspwtlon Intormatlon
Pro)ect Reprasentetive Phone
Address
I Certlfy that I have examined thle applicatlon end stats that the Information contained in it and submitted
by me or my aqent to compile safd applicatlon Is trus snd correct.
SIflnature Date
J
i
DEPARTMENTAL REVIEW
. , -
App~ov ~nd. Hold
* Approval
Environn~sntal Hesith Application N ~
W.1101 Colleye ~
Room 200 r ~
~Planning/Zonlng
~ N. 721 Jefferoon RWS
' ErplnMrs ~ 7b`
~ N. 811 Jefferoon
Utllitla
❑ N. 811 Jefferson , .
,oPlan Rwlew/Fln Prwwtbn M~
~ N. 811 Jefferaon
,
;
OtMr (SEPA/Cr1Ucal Mabrial/etc.) '
❑ t
;
i
~
❑ at Trai*/Spedal tnspection InformaNon
Pr+ooct Rspresentative ' Pnone S
Address {
I
~
I certify that I have examined this appllcation ar►d atate that the Information oontained in it and aubmltted '
by me or my agent to compile aald applicatlon la trua and oorrect. SIgnature Date
1
. . / / ~
N.~►~~~~r~_!~ I ~ y~ Bus lness Naine
IL AdJ r~!bs
,'l~, • .z D C, PhOlie - - -
~.,►~~~~c ; l:uiitact F'erSL)n M.S Yhuiie No. 456-36UU
c:ohthlEItC LAL Bll I 1.DI NV PEKM t'f !{.tV IEW
fi, i~, tmi ldint; permi t rev iew is intended tu appraise you of the improvements ( roa(iway, sltie-
wal~ , curh, stura,water, etc. ) which must be cunstructed in association with yuur builciirig
;)Crali[. This ctiecklist will be filled ou[ by ttie Engineer's staff and a copy will be rc:-
turned tu yoti at the time that the permit is ini[ialed by the Engineering Department. Al1
i-vyul reinents shal l be completed priur to isauance of the building permit. All unchecked
buxvi ra(juire additional rebearch or information to make a determination.
l. 5tormwater DrainaKe Considerationb
A. Per gufdeTiiies tor "S[ormwater Management 1981" both on and off site.
1. 2023 (:onsiderations* M Yes ~ No
2. Flood hazard zone considera[ions** Li Yes ~ No
3. Storm Drainage Plan ~ Yes ~ No
11. Planning Action #40 C`z, -\a,~~~ O'(1S
1. Rezone, Conditional Use or Variance on property ~ Yes ~ No
2. Are requirements of planning action incorpora[ed ~ Yea ~ tiu
into site plan
I1 l. kight of Way
1. Does permit neceasitate R.O.W. dedication Li Yes 14 No
2. Did zone change require R.O.W. dedication ti Yes ~ No
3. Radius a[ cocner Li Yes ~ No
1V. County Road Improvements
1. Roads need to be improved. How wide Li Yes ~ No
2. Curb Li Yea ~ No
3. CRP/RID agreement (Copy of deed, contract, or Li Yes ~ No
Litle report required.)
4. Plans for improvements provided Li Yes ~ No
5. Sidewalk Li Yes ~ No
V. Parking Plan & Approach Location
1. Review and sign uf f by Traf f ic bi Yes ~ No
`l. Approach Permi t f rom Engineer' s Off ice Li Yes ~ No
3. S[a[e or City sign uff ~ Ye8 ~ h"'
4. Ts this road on 6 Year Plan Yes ~ No
~ Yes
. ~ . CI (Il Ar*,r'c:emtnt :
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