Evergreen N 4315 SS Cyril Methodist Church Mtg Hall
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(THIS Is (dOiA PERMIT)
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BUILDING PERMIT APPLICA1I0N WORKSHEET ~
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PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAIVD
COMPLETE IN INK
(Plesse return this origmal and your building ptans to ihe Department of Bu(iding and Satety)
SHADED AREAS ARE FOFi DEPARTMENTAL USE
P►oiect Nurnbsr
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Owner aNeme LAST FIRST MI
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DEPARTMENTAL REVIEW
Approved Cond Hold '
Approval
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Eirvironmental Heelfh Applfcatlon N
W 1101 Collepe
Room "200
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Plennlrtg/Zoning
N. 721 Jefierson
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N 811 JeNerson _
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/Utllttles
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Plen Revlew/Ftrs Preventlon
❑ N 811 Jetlerson A- 3 uvvVJL 3oe
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Other (SEPA/Critlaal Matertal/ete.) ~
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Faat Trick/Speclsl lnepectlon' Intormetlon -
Pro)ect Aepresentative Phone
Addre9s 1
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I certlfy that I Aave, examined Ahi9 eppllcatton and state tAat the Intormatiom contained tn it and submitted
by me or my agent,to compile eaid applicetlon is true ard correct `
• 3 ~ - Signature z Date
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w....Lo« recgon Name G'0,J4)iP. -$=r2.4 Buainesa Name S. S. IC '
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Addce.ss Aclr~rese rof
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Ptione ~h_ g S ~ ~o F'Iione
dlulw~ A ~r-ount*y Contact Perean ahat e~'So Aj Phone No. 456-3600 Date
COrfMERCiAL BUILDiNC pERMiT REViEw
This building pecmlt review is intencled to e
ppcalse you of tltie improvements (roadway, side.
walk, curb, etormua[er, etc.) wtiiclt muBt be constcuctNJ In assoctattoit with your building
pecmit. Ilfie checkltst aill be filled out by [he Ecibineer's staff snd a copy wi 11 be re-
turned to you at the time thet t1te permit is initialed by tltie Erigineecing Uepactinent. All
requicemerice ehall be completed prioc to issuarice oE the butlding permit. All unchecked
boxea require adclitional research oc infocmetion to make e determinetion.
I. Stormwater rrntnag~e Considerations
A. ~er gutaelliii sjoc 'Stocmwa[ec Management 1981" both on ond off ce.
1. 208 Considerations* Yee a Ho
2. Flood hazacd zone considerations** ~ Yes, p No
3. Storm bralnage Plan Yes p No
II. P18nning Action U
1. Plet, sliort plat, rezone, Conditional Use oc Varience ~ Yes ~ No
on property. Plenning Number
2. Are requiremente of planning action incorporated p Yes ~ No
into eite plan
I I I. Ri ht of Wa y
l. Ooes permit aeceasiCate R.O.W. dedication ~ Yes ~ No
2. Did zone change cequice R.O.W. dedication p Yes ~ No
3. Radiue at coraec a Yea a No
IV. Courtty Road Improvements
1. Roeds need to be improved. Now Widu a Yes ~ No
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2. Curb a Yes ~ No
3. CRP/RID agreemen[ (Copy of deed, corttract, or ti Yes ti No
ti tle ceport required. )
4. Plans for improvemeats provided • p Yes Ll No
5. • Sidewalk ~ Yea Li No
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Y. P'arking Plan b Appcoach Locetion
1. Reviev and aign ofF by Traffic ~ Yea Li No
2. Approach Permit f rom Engineer'e Of fice a Yes tj No
3. State oc City eign off Li Yes Li No
4. Ie thi9 road on 6 Yeac Plan Li Yes Li No
VI. t1LID Agreement: Li Yee I No
VII. Field Review: Preliaiinary Comcnente
All lend vithin the AQuifer Sen9itive Area, where deemed Eeasible by the Coutlty Engi-
neer, shall incorporate etormuater trea[ment to mitigate tlte po[ential for groundwa[ec
degradecion. (See Cuidelinee foc Stormwater Matiagement 1981, Spokane Board oE County
Commiseioner'e Reaolution No. 80-15929 ae amended.)
The purpose oE flood hazacd zone revieW is to minlmtze losaes due ro Flooding in spe-
clEic ateas deelgnated by Flood 1lazard Dounclary maps on f ile at the County EngtAeer'8
Of f ice. (See Spokane eoacd of County Comiaiesiotte c's Resolution No. 81-0126, as
emended.)
8/22185