Montgomery E 9503 HP Christy Co - Office Bldg
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BUILDING PERMiT APPLICATION WORKSHEET
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PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNOERSTAND
(Piease return thle originat and your building plans to the Qepartment oi 8ullding and Safety)
1
t owner's Name ¢eatl (firot) ~m1 oepertment ueeonly
H- ~ ~-t ~ ~~~~~~1~ ~ ~ ftm ~ Oomm ~ ✓
2 P+ra)ect Addrm (w Meilirfp Addraea) a Road Nelme ~ C~ i'~ ~A space '~~wv u' U t~~ ~~T ~P
E qgD,,~ IUlotitT~,.~~R.`~'
3 pty/Oommunity State Subdlvlsion/Plat Name
W1114 eN 1e4z E "'s 5 AGRe- 7rF,ACI-M-7
A=MW Np LOl QIOik
/ ~ w rt + OEPARTMENT USE ONLY +r t*
S Sic Gbde Zons /1cf. N Z~one Pr0{ect No ~
8 Owelt ~ No of Bultdinqs Sq Fi /ACre Oepth Ftantage
7 S~ gadc.Frpnt (l.~1 (R)S-2 Rear Gbnaus Tract MoQute Mo Initiala
•
~ 16 Arohltect F7rm Name 8treet A►4dress
f--W0 W(o N (of tlP ~ •
p~ ~~.~-i ~50°1 ) ~2g~ `1(v2b
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Conted Pew ' Phone ft dlfletent than above
t'-\N 1 )~Slb m
~ ~ ~ Street Addma
P'A1•CO CZ>44z"-L~1ot...l. 1W-.,. 408C77 E kAC*JT604AEXY
Zip oty.~.~! sud~t~sN Phone uoen~e No anone u airre~r+c than abo~►e
Oontad P+ereon
GI ! Q~Gs ( !
6 Owner/Agent (If dlffaent IAan 01 abave) Buslnass AdQtm
r
9 Zlp Gty S'tale Phone
t 1
12 qeWew Raqu}red Plan Gsedc (Y/N) Othe► (Y/N) SEPA Exempi (YIN) Oeis
15 Type Woric BtdQ O MH New O Replane O Olhet
O Flre O Demo AddlAlter 0 Move
14 QeacrlhOVYodt '
~ 4PF-pl~ ~
10 Appllcsnt Name 5lreel Addre.u
tl Zlp Gty Stete Phone
! : ; ~ •
~r Street Addreaa
Zip City Sta1s Phone
centm perwn ~ Phone if different ihan above
{ 1
aadirronai inrorn+arr«+
~~T C44 # ~UPS ~ UV P. C .
44900 ,Np fAA.. 1 .7 Z 1 Si
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COUNTY ENGINEER
r.~~•ROBERT S. T,URNER
COUNTY ENGINEER
SjrozL%.e-zc qW.%n=zd~uv4ra- 99260
SPOnAIV[ CLUnir COURT MoLISt
May 27, i'986
Inland Insurance Association
P.O. Box 3585
Spokane, WA 99220
RE: BuildingPermit
E. 9503-Montgomery
Gentlemen:
Please be advised that the bondifor the above-referenced building permit,
dated June 18, 1984 by Safeco Insuraace Company of America, in the amount of
$17,700.00 for roadway improvementa, may be released.
If you have any questirons, feel free to call ouT ofFice.
Very truly qours.
Robert S. Turner, P. E.
Spokane County Engineer ~
~
Jerr Sime
Sen or Plat Inspector
JS/lvb
cc: Panco Construction
Public Works Building North 811 Jefferson Street Spokane, Washington 99260 (509) 456•3600
Y +~I xnr ~ Cla " 5 I ,
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COUNTY ENGINEER
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ROBERT S. TURNER
~
COUNTY ENGINEER
Brossarm ,WAggsn+rarrox 59260
bPOKAat C04,nir "UR"R NOU3t
98~
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Subdivieion Name : f3w• s sa y le
/o Js ~'f o AV r IF
Dear Sir:
4ne of the requirementa eet forth by the Spokane County Planning Commis-
sion in connection with the abave-titled plat involves the filing with thts
office of a Street Improvement Boind. A preliminary inspection of the plat has
been made by this office and the amounC of the Street Improvement Bond found
to be:
$ f 00 ° o
A Street Improvement Bond in the above amount muet be filed with this
office prior to approval of the final plat. The bond will be released only
ugon eatiefactorq completion of the required etreet improvement. Please
contact thie office whea work on the improvement ie ready for inspection, or
if you deaire additioual inform$tion or advice conceraing the work.
.
Very trulY Youre, b
Robert S. Turner, P. E.
Spokane Couuty Engineer
Bq
Public Works Building North 811 Jefferson Street Spokane, Washington 99260 (509) 456-3600
►
~A
ITEM # --STD-RQAD-TTEMS UNITS QUANTITY --PRICE C~ST '
~ ~..~~~~ir
° ib) Monuments EA
17) Parricate EA
18) 5treet Siyn$ EA
Road Name A_DLjljp&~.~-~
Section #
Width ------7-&
,
19) Rough Grade Ly ~ 1 dp 7 0
20) BaBe Course CY
21) Top Course CY Z342, 22}, Asphal t Concrete Ton3 m~
23)~ Curb Type A LF / 4'
24) Cur"b Type P, LF ,
23) Curb Type R LF
26) sidbwalk SQVn g17 e-, 13 q0
,
° lcoqlb t~am*
5ect i on #
Wi dth
19) Rough i3r ade CY 23 -3
70) Pade Course CY
21) Top C6urse CY 15-2- ~ t t
~
223 Aspha1 t Concr-ete Tons 3050.
Curb Type A LF 3o t4 9 4-4.
24) Curb Type P LF
25) Curb 1ype R l-F o
26) Si dewal k SQYD 1
w
~ Road hiame
Secti ot► #
` Width --0
19) Rough Orade CY
20) Base CourSe GY ~
21) Top Course CY
22) Atphalt Cbncrete Tons
23) Curb Type A LF
24) Curb Type Et l-F
25) CXwb Type R LF
26) Sidewal k SQYA
~ON_ST~,IN~ARD_ROAD_ITEMS...............................................
~
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Cont ingenr_ v i n
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BOND EST FOFh
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a PROJEGT_ '4. 1'JQ„LL"~ NAh1E_ DATE__
Item_#------ Urainage_items_____UnitsQuantitY___CriceCost
~
i? Drywel l- Type A EA F?0 09
.
2) Drywel l- Type P EA 11SO112-
3) Gr at e- Type 1 EA o~ a 6,D
4) Grate - Type 2 EA
S) Grate - Type 3 EA
as
6) Bac ttf i 11 f or DW CY ~ Q ~ 7) Concr'ete Inlet EA
8) C.M. pipe 10" dia. LF
9) C. P1. pi pe 12" di a. LF
ia) C.M. pipe 15" dia. LF
~ 11) C. M. p i pe 18" d i a. LF
12) Frecast Manhole EA
~
13> EAlid Lid EA
14) Di tch Er.cavati on CY
15) Sod SF ,
. ;
-
T~MS------------~--------------- - -*R*
2)
a)
4)
3td Bdl DwI Conc _ __Di a Di a Di a OTHER
Page Dwl Dwl bi~F Inl et F1 pe F'i pe ~Fi pe
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2)
4)
5)
6)
7)
~ • . ~40i2:ii11= Y~± 675; FACE 778
/
Ttansilimerica. Transemerica
~ Title Insurance Compeny THIS SPACE PROVIDED FOR RECORDER'S USE ?
Ttle Services ~ . t
0440
i♦►es ~~a• f
dwa"m
~ r_ ~r ~~yil 1s~s '
. ~ : .I~. . I: =~I-` ~ FIL-En oR REM
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11P: WILLIAM F _
[j0ltAHUE
~.,,.~I.i~•~~~e : 1:
AUOITOR
0 '
WNEN RECOROEO RETURN TO SPOKANE COU TY. WAS •0
RECE I VEp 1 DfPUTY H' ;
Name~_ Mc=M -4 HEMW~ P.S.
~ MAY s
0 1984 ~ .
Address Nw ..122 u1~VC'_Y'S4ty__
PANCO COHSTRUCTiON, INC.
city, seate, zip ..5po1rAie_,_[nTa$ht,ngton 99206 i
• •
Escrow #4810 Statutory WarrantY Deed
THE GRANTOR BAIBARA F~,'Y, personal representativ+e for the estate of LILIA BLEW,
dec~eased,
.
tor and in cansideration of 7EN LOI,I,AR.S ($10 . 00 ) and other valuable vonsideration
ui band peud, conveys and warraats to SPOKANE LIEVELOPNENr, a partnersha.pp
the following described real estate, situated in the County of SpOkc3nH , State of Washington
The South one-half of the following described progerty. The West 126 feet of
Tract 5 of WARRM' S 5 AGRE TRACTS, as per plat thereof reoorded in VolLUne "C"
of Plats, page 58;
TOC~.T]ER WITH a vacated strip 10 feet in width lying West of and adjac:ent to
said progerty;
Situate i.n the Qounty of Spokane, State of Washi.ngton.
SUBJEC,'T TO: Easements, restrictions and reservatians of reoord.
Extise Tax Paid on 284755
Sele Amt Pd -oy~a? gpe-,
D E "SKiP" CHILBERG
SpokanQ C unty Treas.
Deted..•~~~ w"+►':jAnuuy 2 3 ,19 84
~ I0GLEY, personal representat3.ve
f~8~ ~ Ge of LILt~A BLEW, deoeased ~
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3TATE OF WASHINGTON STATE OF WASHINGTON
COUNTY OF S90kane sa COUNTY OF . . . , so
On this day personally appeared before me On t}us - day of .19
,
before me. the undersigned, a Notary Pubuc m and for the State of Wash-
BdrbaSd Mla.gy _ ~ ington, duly copunissioned and sworn, personally eppeared
to me knawn ta be the individual described m and !
- - - - - - - - _ _ . .
who executed the vatinn and foregaing irystrument, and. . ~ ~ .
and acknowledged that Jc3h@,.. eigned the same to me known to be the President and 3ecretary,
as 1= free and voluatary act aad deed, mpectively, of
for the uses and purpnses therein mentsoned the corporation that executed the faregaing instiuinent, arid~aaknowledged
the said uLstrument to be the free and voluntary act and deed of said corpor-
abon, far the uses end purposes therein mentivned, and on oath atated the!
authonzed to egecute the said instrument and that the seal
GIVEIV t~ider my hand and official seal this affxed is the oorporate seal of satd corporadon.
23rd day~ '~f . J~. , 19 84 VVitness my hand and offcial aeal hereto affiixed the day and year first
~f above wntten.
_ .C~ • ..-1 -4,r- . » . » . _ ~ ~ . . .
Notary F uun and fo the 9tate of Wasb• Notaty Public m and far the Statg of Washington,
ington, residmg at SP0k@pe_.. ~ residang ak . ~
Fbten Ida W-96A Rev 4-76
d
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S='A''p
a ~ STATE OF BusINESS ucEwsE cEwTER
WASHINGTON CERTf FICATE OF TRADE NAM9 Oepartment of Lioensing
Department of Lrcenaing afympia, WA 88504
~ laa9
Phons. 1-800-582 8203
12081754-2786 •
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Chspter 19 80.010 RCW requirea eny person who conducts buslneas in the Stete of Weshington under e trede nanre or essumsd nerro of eny kind to tilo
a Certifir.ate of Tmle Name with the Washmgton State Oepartment of Lioensing.
A Trade Name is (a) e name taken up or adopted by a Rerson which does rtot include tha true and resl neme of thet peraan. (b) eny narrts othsr than
tha reai snd uue rtame of elt peraona ooRductmg the business.
A Aeal end True Neme is (a) the wrnarne ot an individual oovpted with one or more of hislher initiefs or nemes, or any combination thereof; Ib1 tlra
name by which s person es 6est known and called in the bustness cortirttunity where business is tter+sscted, if thia is utied as ths tegal signowre.
The twsinets must be regiaured as e Trede Neme if
t. it dces Rot contain the namss of al{ the ownera, whether these nemes aund alone or are coupted wlth other words dasuibdng the butlrtess,
2 it contelns e nicknmrte wkh the iurname when the iadividusl uma a differ+ent name ea a legel stgnatute,
3 It eont0ins neMes or initiata with the sumeme which are not the indivtdue{'a real neme or inlttels:
4. k conteins words wh)ch auggest additional ownera, such s: "Company", Aasociatw, Sons".
A Not7ce of Cenceltatlon murt ba fited when the Traie Necne is no longer betng used in the State of Weahington by the parsanie) iisted on the Cetttflcctte
oi Trade Nmne ss illed with the Oepartment of Licensing.
A Certificete of Amandment must be fited when tfiere is a change of any address, tndividual'a tegai name, or oountiee where the Trade Name ts to te us3i.
Any other change requires filing of u NotEOe ot Cancellatian ot the orlginal regiatretion end a new Cortificate of Trmfa Name.
Required signeturea are
1. Indivldunl: - the aignature used on dhecks end documents, .
Z Mamed individuats - the atgneture of one rteember as representiRg tRe nior" oommunhy.
1n complfanre wich Chaptw 19 80.010 RCYV, the undersigned perwn(a), being first awom, attest thet the stoLentents on the reversa ade of thia eertificm
are tnre, and that the nameiel appeering therein islere the true and resl nomslal of ths undenignsd.
-6gnawr S"
,
sign re Signeture
~igneturo Signature
i hereby certity thet on this date p8rsonetly eppeared before me the ebove namedperaort(s) to me known
co be the indtvldualtsl desaribed and wltio executod ths foregaing instrument ond ecknowledged ttat tfis
above nrmed figned eral sealed the ame aa-4hGlf' lhis,her, ar tfielrl tese and votuntary act and
deed for tfu usas snd purp6ses heretn menttoned
G►ven under my hand end Oftteief Seol on 1964-.
. • Notery Public
In end tc~r the State ot reaidtng at .
OLG•700-051 Certlflcate ot Trade Na ot 2)
2A17182I - -
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CERTIFICATE OF Tf1ADE NAME
IPrtnt or type alt infornptlon on thi' aide.l
~
Trode Narne to be Regtmred SPOKANE DEVELOPMENT _
Mailing Addresa P.O. Box 3164 Spokane, Wash3.ngton 99220 phona• ~01 4R4-1850
Check(-*/) countles in r+fiich Trade Name ts to 6e u6ed: _Ot•Adems ,09-Douglas _17-King _25.Pacific _33-Stevctns
-02 Asotin 14Ferry _16-Kitsep -26Pend Oreille -34Thurston
- 03Benton -11-Franklin 19-Khtitaa -27-Pierce 35-Wshkiokum
-04-Chelan -12-Geriietd -20-KlPckitat --284an Juan _36►Wella Welle
_06-Clellam _13-Grant 21-Lewis -29-Skegit -37-Whatcom
-06-Clark -14G►aya Harbor -22-Lincoln _30Skemania I&Whrtmann
_07-Columbie _i 5-Islend 93-Meson 31-Snohommh 19-Yokima
-Q&CowNtz _16-Jefferson _240ksnogen E32-Spokene
Peraons oonducting or intendmg to conduct business under thit Trede Name or havirtg en intereat tharein
HODGES, JOHN jpw1/--1fZ0 N. 682R Fotherinqham
L.est Name Firat Name Middle Name Blrthdete Mailing Addres4 SPOk8Ae, WA 9-920
CARUSO , LARRY a5fl 4 La°ne, 'p2►rk Roacl
laat Nenre First Name Mtddle Nense Binhdate Meiling Address M-ead , iaA 9902
KETTLESON, EARL e-2 7_ 46el /
Leat Name First Nams Middle Name Btnhdate -~lV'laili ~ S O~C e WA
, o
RICHMOND, TOM Ave.
*
Lest Nams First Name Middla Nert►e 8lrthdy . 316 '~S Nteiling Address pokane, W~2 ~
Lest Name First Name Mlddfe Name 8irthdate Melltng Address
last Neme Fint Name Mtddie Nems Birthdete Mailing Addreu
TpADE NAME REqJSTRATION FEE M00 MAKE CHECKS PAYABLE f0 STATE TREASURER
On reverss otde, aign and edcnowledgs thts instrumeot
betore e notary public.
8e su,ro tho notary seal b tegibte.
9LG700.051 (Slds Z ot 2) ( R/7/82) Sie^ your nams oxootfy a' it is antsred abovro.
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DEPARTMENT APPROVALS ~
This is nct . oermit ~
ApplfCation Type
(Standard untess (Indicated approvals requlred In elther'retease" or "release with condittons'
otherwlse Ind(cated) apaoe prior to pennit Issuartce
❑ Fast Track '
[3 Earl y Start Rel Release w►co
❑ t Y
Environnrentel Heslth 0 Commercial, O Residentlal
W 1101 College D New Construcflon, D 81dg alteretionlad0ltlon
Room 200 ❑ Additional structure,
APPIICATION #
/*07
Condtt(ons/Comments
,
- - -
❑ I Pisnnirtg/Zoning ❑ Comrrtercial. 0 CeM of Exemptlon, O Frontage, G ,
N 721 Jefferson Ca Setbacks, 0 lot w/d, O lot size, O use/r.one.
CU. varian to cr ng sh It ~ O tence,
• Other ~ ~ ~~-S•~
Can tionslComments :
s .
Cl Englneero. mmerclal, O Residentlal; -II -Fiood Plain,
N 811 Jefterson ralnage O new accesslapprt,at1~f ~ 0 tence. ~
road tmprovements ~
Conditlons/Comments.
i
~ uuuties• ~ Z
N 811 Jetterson ~
Condltlons/Comme s ILLA,Q LlmV lsmbt
« sl
~ ,4 t
❑ ~ ~L!
Olher, .
❑ Pten Exem
Fire Prev.
Cortdltions/Comments
a i~Z ~
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Project Representative Telephorte
~ Agencles Pertorming Special lnapection
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E- E Z
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3.
' 1 Indkats above or attach oon/Itio~s reIathrs to flnal as bulH epprovsi
2 IndkaM abovs or etmeh ruaons tor hold
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E. Montgomery Av+e. #'1ap1
~ 08542 1816
comm. Bidg. ~
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NOTICE TO THE PUBLIC
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KNOW ALL MEN BY TNESE PRESENTS, That Spoksae Developxneat, aWrtnerehApT
e ng the owners of-The fo1lowi ng described"Tands in consi"deraflon ot mutua f-benefiTs-
tp be hereafter derived do for themselves, their helrs, grantees and assigns, hereby
agree:
To authorize the County to piace their name(s) on a petitfon for the formation
of a ULID by petition method pursuant to RCW 36.94 which the petitfon inciudes
the Owner(s) property and further not to obj ect by the signing of a protest
petition against the formation of a ULID by resolution method pursuant to RCW
Chapter 36.94 which includes the Owner(s) property. PROVIDED, this condition
shali not prohibit the Owner(s) or Successor(s) from ob3ection to aRy assess-
ment(s) on the property as a result of improvements called for in conjunction
with the formation of a ULID by either petition or resolutlon method urrder RCW
Chapter 36.94. This statement involves the following described property:
The South one-half of tha following dsscribed pmperty; Tb,e WeBt 126 ieet of
Tract 5 of Warren'e 5 Acre ?racte, as per plat thereoY recorded in Volwme "C"
o f Plate, parga 58;
TO~THER aITH a vacsted etrip 10 feet ia vidth lyibg Mest of end adjac0nt to
eaid property;
Situate in the Couaty oi Spokane, Btst,e of Wash
ingtoa. ,
SUHJECT TO= B'a8emeatQ, re8tricLions aad reesrratione of record,
fXEB OR RECqtiQn
' RE^IVESY tc- County Eagineer
JUN 16 12 14 PN '14
WILtIAi1UNTy, DONaF1Wg
S'oKANE I YASIL
DEPUi'Y ~
Req Court House xxx
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These requirements are and shall run with the land and shall be binding upon the
owners, their heirs, successors or assigns.
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7C f A-4 d do'
STATE OF WASNINGTON ~
} ss
COUNTY OF SPOKANE )
On this_.tj * day of , 19A, before me personally appeared
persona fly known to me to be t e n v ua fT sT-aescribedherein who executed"Ue
foregoing instrument and acknowledged the said instrument to be the free and volun-
tary act and deed of safd individual(s), for the uses and purposes herein mentioned.
Given under my hand and seal this 21 day of , 193¢ .
, ,f y
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r o ary u c, n an or e a e
" of Washington, res- cl g in Spokane,
Washi ngton.
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- NC ~IYES"rRUCTION
RECEIVLD
September s, 1985 SEP 0 91985
SPOKANc CO,jffrY Er`GINEER
Spokane County Engineers Office
N. 811 Jefferson
Spokane, Wa 0
~
Att : Gary Nelson
RE: . Montgomery (Boron Properties)
Gentlemen:
Pursuant to our telephone discuseion, we herewith confirca that the
development of curb/sidewalk, for this project, shall end five (5)
feet short of the west property line on Montgomery Avenue.
We have agreed to install the remaining five (5) feet of improvement
at such time as develpoment to the west occurs. This agreement is
made in order to accomodate the private driveway to the west.
Sincerely,
PANCO CONSTRIICTIOPT , INC.
/
Ronald A. Sahnow
President
RAS/J
cc: Villege Square Realty
y t ti
~A Cc
Panco Constrtirtion !nr •E 10W5 MnntqornPry u2•P 0 Qov 13388• Spokar,f V1R 99213 3388 9509d922-0600 • L+c 9PANCO C! 19QC5
.
Contact Pprson Nar-•- 1'~ 4/ U--io~/ - - BusIne•. N i-,
-
Address~ AJ,1rvti9
Phone Phonc- - , ^
Cnuncv ~o~~~~rr pr-:~in_ P~~c~i~a Nt-. ~'+',6-3h11i1
CUMMEKCIAL RUtI,UINC PEltMCl ltt;VlkW
Thi-i bui ldto1g pecMtr cevtew is intended [o appraise you of the tmprovemPnts (roadway, side-
walk, riirb, -tturmwir-r, e[c.l which mitst bP cvnstiucCed in association wiLh ydur buildirg
permi t. Th 14 chPck l is t wi 1.1 be f i 1 led ocit hy the Engt neer's staf f and a copy wil l be re-
turnpci to you at thp time thAt the pecmtt i4 initialed by [he F:ngi,ieering bepartment. All
requtrement4 shall be campleted prtor to Issuance af the builtling pecmit. All unchecked
boxes requice Additional reseerch or informatton to make a determination.
1. Stormwater Orainage Considerations
'A. Per gufTe-nneR for 'Stormwater Management 1981" both on and ZYes ite.
1. 2()$ (:onsi derat ions* ~ No
2. Flood hazard zone Gonsiderations** Li Yes No
3. Storm Dcainage Pian ~ ~ No
II. Planning Action # I ~S
1. Rezone, Conditional Use or Variance on pr4perty Li Yes ito
2. Are requirements of planning action incorporated ti Yes /No
into site plan
III. Right of Way
1. Does permit necessitate R.O.W. dedication Li Yes t5/, No
2. Did zone change reqtiire R.O.W. dedication Li Yes No
3. Radius at corner Li Yes No
IV. Covnty Road Improvements
i
1. Roads need to be improved. How iri de a y h Yes tj No
2. Curb Yes Li No
3. CRP/RID agreement (Copy of deed, contrACt, or Li Yes ~No
title report required.)
4. Plans for improvements provided
yee Li No
nl~/
5. Sidewalk Yes ti No
V. Parkin Plan & Approach Locatioa
1. Review and sign off by 1Yaffic Yes ti No
2. Approach Permit from Engineer'8 Office /Yes tj No
3. State or City sign uff ~ Yes ~
4. Is this road on 6 Year Plan ~ /Yes No
VI. ULID Aoreement: ~ No
VII. Field Review: Preliminary Comments
* A11 land within the Aquifer Sensitive Area, where deemed feasible by the County Engi-
neer, shall inc4rporate stormwater treatment to mitigate the poten[iat Eor gro undwatQr '
degtcedation. (See Guidelines for StormwaCer Management 1981, Spokane Board of County
Commiesioner's Resnlutton No. 80-1592, as amended.)
The purpoee of flood hazard zone review ie to minimiae losaee due to flooding in spe- ~
eific aceas designated by Flood Hazard Boundary maps on file at the CountX P.ngineec'e
Office. (See Spokane Board of County CommiRSioner's Resotutian No. 8I-0726, aR
amended.)
4/1,1/84
.
BUILDINQ PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY tHOSE PARTS OF THE FORM YOD UNDERSTAND
(Piease return this orlglnel and your bullding plans to the Department of 8ulldlnp srtd 8afety)
t Owner'e Nan+e ~ (tsetj ~ _ -(first) (R+) Osp~rtmsnt WieOnly
~"t' (~~y 60"P~~y i~° Cc~nm
2 P1"oied IWdrees (nOt M8111np AOdroee) cr RoM! Name g0ace ZiD
E~ 1,401 1
3 py/0ornntuntty 8lite SuOO1vIsIon/Plat Name
tQ:34,N4w E 1~l N W~~ Ac-Rr -rAAc-rs
1 Aeema Prnoet No Lot Black
w w OEPARTMENT USE ONLY
g Sic coft Zom Act 1 Zone Protecl No
8 pwetl / No of Bultdirtge Sq Ft JAcro Osplh Frvntaps
T 8s! 8edc Fr+oM 0.i&1 (q)" Nev OKrous Tracl Module Nb Inlthls
• 18 ArdiltM Rlmn Narne 81re~t Addreea R
f--N"i KlC-D EP Glqa~ ~ry ~5~1 )~52& '1(~28
F
a~ F+eneon Phaee n aina►ene tnd+ ebotia
( )
OonlncW Flrn► Ftanre 8troet A40roee ~
pAtW,p ~^..o~.~ r or`.1 I►~. tD6o"1 I~a~rt'&o 4.~t~Y
Zip ~ ~~i 22v a,5,+ s~~ p w+«~ ) gqL'L dqc%=1
F ~
aondo aareon ' uoenae No Ph" ii dqrremt ftr, abwe
lrb
8 Ownerlr4pnt {tl differeM t NMn t ebove) Buelnees Addresa
9 Zip Gh► 8tate Phatte
l )
12 Re+rlew Requlrea Plan Cheek (YIN) OtNe► (YIN) 8EPA Exemp! (YlN) Onte
16 Trpe Work O 8fdp L] MN O New 0 Replacs ❑ Other
Q Fire ❑ Demo C] Add1Alter O Move
~
14 Die~Ctlbs Work
10 Appflcant Nome Siroet Addrom
11 Zfp Clty SEets Phone
• ~ •
Lender 8tred Addrem
Z!P Gty SMte Phone
l 1
~
cbnract P+eraon Phone 11 dlffeient tAan eb►s
f 1
Add f I tona I I ntormet ton
1
SPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
• ` NORTN 811 JEFFERSON
~ SPOKANE, WASHINGTON 89260
(509) 456-3675
~
~
~ I certify that I have exammed this permit and state that the information contained in it and submitted by me or my
agent to cornpile saici permit is true and correct in addition, I have read and understand the NOTICE provisions included
herein and agree to compty with same Atl provisions of laws and ordinances governing this type of work will be
complied with whether specified herein or not The granting of a permit does not presume to give authortty to violate
or cancel the provisions of any other state or local law regulating construction or the performance ot construction
~
~
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
~
400 aoowCss: sao..s ow*es PRoJO:
9503 E MONTGOMERY AV 0000374 05/30/84 00000406
owasa
CHISTY COMPANY, H D S.E.P.A Fee $35.0,
wooasss
~ 9503 E MONTGOMERY AV Plan Chk Structure Fee $975.6
clTV sT i1r
SPOKANE WA 99206-0000
wrrLIcwMTa
PANCO CONSTRUCTION 4 r 0•00 7A10
~ CONTRACTOR ~ -D~ ~eQ
P AtJCO C0~lSTR UCT I ON 50.
woowessa
~ 10807 E MONTGOMERY DR
c17v •tt slpa
SPCII<ANE WA 99206-0000
•N LiCa1459,07
~ 509-922-0600 PANCOCI190C5
wwew/t«a1Nt`a
EWTNG MICKEN
wDoNsss:
~ 6116 u c sT
~
„
SPVKANE WA 99205-0000
'
rAqCtLS CtNfY• TRS INi'tCTORi
085421816 0999
PLAT' LOT at •LOCK tINAt
OD2544 000 000
,
P{.AT NAMC
' WARREN'S FIVE ACRE TRACTS
zoMCS :oNt ►io t• f s• a ws• Moo
' RI 043 032 004 068
usa o► ►swMST: ~ass- Pwio svi ew ex ca MI
` OFFICE BUILDING $1,010,65 X
JOG AOOACfS COYN1'tA APr3 PLAN• l7CAM OATr
9503 E MONTGOMERY AV 05/30/
D E P T R E V I E W W Q R K S H E E T
PLAN CHECK STRUCTURE TOTAL FEES $975.65
Uescription N OFFICE Group Ti-2 Type VN
Square feet 012500 Occupancy Load Oi 12
~
u '
~
~
~
I
I
~ I
I
• • .
~
l ~ }
!
• 4`tto ' - _ q l l ~ ' +
~z?• ~"i
ti~• BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNOERSTAND
(Please return thts originai and your bulldlng plans to the Oepartment ol8ulidinp and Safety)
1 Owrw'a trams pa~tl (tirst) (m) oep"ment uae diy► ~
p.~ ~ ~"✓N ~-Ql~#~+b..1~.I~ / --~~b.l~l~ 't7~1 . Rae. aomm ✓
a PtaW Aaddrom crto! Metlin0 Addresal o Raad Name 'lc,~ $vWe Zip
~ Q1~~ I~od~JT~~~lZY~ '`I eCZ5' +4A" u-tOti1 'C-;'FEE;T-
9 dty/0onanunlty State Sotbdlvlslonlfiiat Name
~ `-R~At~l E WA~.~E►•s'S ~ A~~ -r~c,Ts
4 Asseeeor r-m No Lo! 8tooit
1916 1~ * i t OEPARTMENT USE ONIY * s w
5 Sic Code Zons Ad t Zone Project No ~
8 Owell 11 No of 8ulidin{e Sp Pt /AQro Oepth Frontap
7 Sel Bedc~ (l.jS-t (R)S-2 R" thresuaTiect Module Na Inttiala
* 18 Arrhlted Rrm Nwe Stroet A,4dreea ~
; F--Wr N~D kArc4/-E r7Rr~' N 6o(tego
~ uo ati Stde Phne
Gi~~'~'v ~~,~►`6~ w~~ (59V--328 -1102b
cbnmac Po eon - - ' plione n aittewt aieu, abo+re '-'W I MfL Jy(,
~ oonaacmw Am+ Nme screet Addnm
E.uc~t1"6o MEPIY
zia ' ary sffiee
~ 4: 9 q 2 1.1,- > WP ~ )
oo+rez Pamon Gl ! otpG~'-,- v~ it ~tre~+t enmn a~.
- - ~
8 Owner/AWt pl diffemmt than 118'bove) gualnessqadress
9 Zip Ciry State Phone
12 RsWew Requlred pian Checic (Y!N) Other (YIN) SEPA Exempl (YIN) Qate
15 Type Work 81dg ❑ MH New O HeAWe O Othet
O Flre O pemo 0 Add/Alter ❑Mo"
14 Descr(be Wbxk
10 ApFJkant Nams Street Address
11 Zip Gly State . phor+a
~ Lender Sllwt Addless
ZIP Ctty Siate Pttane
Clontect Per9a1 PAOrte it ditierent than above
l )
Addttionat Intormattm
~~o ~ ~h~ ~'ti u+ • t~ A F. C .
49 Oo ?,ND fw 2 z
t 2M c4 4c CI-qJ2,
1
CWC5
~D ~ ~ ~ G • I
T ,
DEPARTMENT PPROVALS
This is no# Permit
Appllcation Type
(8tendard unlees (Indlcated epprovals reguired in eNher "rele#se" or •release with condttlons"
otherwise indlceted) space prlor to permit Issuance.) ,
0 Fast Track
0 Esrly Start Release
Release w/cond 1 Hold 2
0 Envlronrnentel Heaith O Commercial, p Resi ntlal
W 1101 Collegs p NewCcnstructlon• D 81d Iteratlonladd Itlon
~ A
Room 200 0 Additional atructure,
APPLI ATION # -2- •
j'F
CondltlonalComments
~ Plennina/Zoning: O Commerclal; O Cert ot Exemptlon; D Frontage;
N. 721 Jetierson 0 Setbacks, O lot w l d; ❑ lot aize, ❑ use/zone; ~
O CU, varianciLh zoria cr ng sh li ~ O tence;
O Other
Can tiona/Commenta•
G~-~- sy tjl;
&A &J='t 9 4, a i ffMd A4
.
0 Englneers: mmerclal; ❑ Residential, O Flood Plaln;
N 811 Jefierson Prnainage O new aaeas/approaah; O fence; sd Improvements ~
Condit(onslCommenta
❑ . utuittes: Z
N 811 Jefierson ~
Conditions/Comments. ~'~'M~I~~ ~ S
.N -
Ar-
- a
El Other.
~
0 Plen Exem
Flre Prev.
Conditlone/Commente
~
0
~
.
~ Pro)ect Representetive Telephone
y Agenctes Performinp Speclal Inspectlon:
~ E 2
~ c
3
t Indleate above or eftach conditlone reletlvs to 11ne1 ae bullt approval
2 Indleats above or ateaeh reasons lor hold
. .
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Plan ~ 406
THkESHOLU DETEKMIN A TION
PRUNUSED/FiNAL UECLARATIUN UF SIGNIFICANCE/NUNSIGNIFICANCE
1. Proponet H P. Christy Co. Inc , Nortb 800 Hamilton 99206
Contact Person. Ewing Michen Phone • 328-7628
1. County's Action Reyuested Buildiny ;permit/Land use permit
PurSudnt to WAC 197-10-203, the Spokane County Department of Buildiny and
5afety, a division of Spokane County, has determined that the county, as an
ACTING AGENCY, is the LEAO AGENCY for the followtng project:
New 12,500 square foat two-story office building
ihls proposal has been determined to not have a siyinificant adverse impact
on the environmenL. An EIS is n ot required under RCW 43.21C.030 (2)(c).
This decision is made after review by the county ot a completed environmental
checklisL and other informatton on file with the lead ayency.
tf y ou wish to ekercise y our option to review and comment as Nrovide in WAC
197-10-203(3)/197-10-340, please respond, if appropriate, at y Qur earliest
opportuntty, notiny particularly the due date for w ritten comments.
Uue Date for wri tten Comments : June 14, 1984
Proposed Ueclaration of Nonsignificance Issued: May 300 1984
I
*~*~**~***********~********~*****~********~*~****************~~f~*******~**~**
Contact: Spokane County Department of Building and Safety
North 811 Jefferson St reet
Spofcane, WA 99260 (509) 456-3675
Attention Kenneth E. Jeffrey
PRUPOSEO DECLARATIUN FINAL DECLARATION
Name ,~~="XK%= Mark Holman Name• James L. Manson
Siynature Siynature.
Ti t le :)0§XXgW Assistant Director Title 0irector
Departmenc. t3uilding and Safety Department Butlding and 5afety
Uate Date
MAILINU LIST
TU Spokane County Planning Department
Spokane County Utility Department
Spokane County Engineering Department
Spokane County Health District
Spokane County Prosecuting Attorney
Air Pollution Control Authority
WA State Dept. of Social & Health Services
.
T
N1 ~ jt
~ t ~e'~p~', 1 ~V ~~~~~•,1~16~ ~~~I~~ y ~
t ~
ENVIRONMEN7Al CHECKLI T
. ~
FILE
,
SP0GAftc COYaf- COYst sOYse
SEC/TWNJRNG:
Introduction: The State Environmental Policy Act of 19711 Chapter 43.21C, RCW, requires all state and lotal
governmental agencies to consider environmental values bo h for their own actions and when licensing private
prcposals. The Act also requires that an Environmental I~pact Statement be prepared for all majar actions
significantly (and "adversely". as per WAC 197-10) affect ng the quality af the physical envtronment. The
purpose of this checklist is to help the agencies lnvolve determine whether Or not a proposal 1s such a
ma3or action. ~
~
Please answer the following questior+s as completely as yo can with the information presently available to
you. Please answer questfons as "yes" or "maybe" if, in lur opinion, even only slight impacts will result.
Tfie reviewers of the checkl9st w111 be aware of and cancern themselves with the de 9r-ee- of impact, asking you
for mare infarmatlon, if necessary. Where explanations of your answers are requlred, or where yvu believe
an explanation would be helpful to government decision-ma~ers. include your explanation in the space provided,
or use additional aaqes, if necessary. You should includ references to any reports or studies of which you
are ar+are and which are reievant to the answer5 you provide. Complete answers to these questions naw will
help all agencies involved with your proposal to undertako the required env9ronmental review without unnec-
essary detay.
The following questlons apply to your total proposal, not just to the license for which you are currently
applying or the propasal for which approval is saught. Ydur answers should include the impacts whith will be
caused by your proposal when 1t is completed, even thaugh completion may not occur until sometime in the
future. This will allaw all of the agencies which will be involved to complete their environmental review
now, without duplicating paperwotk in the future.
No application shall be processed unt11 the check]ist has been compieted and returned to the apprapriate
County department. State law requires ex Qlanations for everv " es" and "ma~e" answer on the chetklist.
fhe person campleting the form may be requ~rea to provide expTanation for no aaswers, and-In same cases,
more detailed inforn+ation to aid in a threshold determination.
NOTE: This is a standard form being used by all sta►te and local agencies in the State of Washington for
various types of proposals. Many of the questions Inay not apply to your proposal. If a question
does not apply, just ansaer it "no" and conLinue on' to-the next question.
ENVIRONMENTAL CNECKLIST FORM
t. BaCKGROUNO
I
1. Name of Propanent: p~,~ r t~TJ CC7 - I~G• Phone Number: ! 85~
2. Address of Proponent: ~ 800 14,41w+ I ITO"
3. Oate Checkll st Submi tted: 2 5 MA►c-l 84
4 Aqency Requiring Checkl ist: SpO 14•ev% e Co._Zl c.~ ~a~ •
I
5. Name oi Propasa 1. i f Appl icabl e: C~ v-t STc.~ ~t~ <<',
~
6. Nature and 8r1ef Description of the Proposal (including but not limited to Size, general design
elements, and other factors that will give an accurate understanding of its scope and nature):
Z sto,•~ o►ce ~lctg 1 Z 500 -22-p.`fi0Tb1 1 760v s~f. 9tiOtpil-
'rt ( T- V p c,c,"c vc7e,
1 Location of Proposal (describe the physical setting of the Proposal, as well as the extent of the land
aree affected by any environmental impacts, including any other information needed to give an accurate
understanding of the environmental setting of Lhe oroposal):
E. °D'¢D J me.*17cIC-1,0" eV* Gav"ev% o# w~o~-i~cJw~ t~r ~
Lac.u sT K1. F. . ~ .
8. £stimated aate for Completion of Proposal:
9. List of all Permits, l.lcenses or Government Approvals Required for the Proposal (federal, state, and
~ .
local - including re2ones): 73t,l1dr we~ .W: LT, gov~.~-u~ t' K-c~► 1~~y1
%4_~
cc,. G,~ 1t~1 s ~ ~
10a. Do yau, or the awner in the event you do not own the subject land, have any plans for future additions,
expancion, or further activity related to or cannected with this proposal? if yes, explain:
N U
I
~ .
y
1 ~
August, 1981
~
' •
. ~
lOb Do you awn or have options on land nearby or adja~ent to this proposal's location? If yes, explain:
L4 a 1
~
1
11. Oo you know of any plans by others including the twner whlch may affect the property covered by your
propasal or land adjacent or nearby3 If yes, exp ain:
1~1 O '
12 Attach any other application form that has been completed regarding the propasal; if none has been
completed, but is expected Lo tre filed at some future date, descrtbe the nature of such application
form•
~
I1. ENVIRONMEHTAL IMPACTS
(Explanatians of all "yesu and "maybe" answers arg required)
1 Earth. Will the proposal result in: Yes Maybe No
(a) Unstable earth conditions or in changes in gedlogic substructures?. X
(b) Oisruptions, displacements, compactlon or ovgrcovering of the soil?. X
(c) Change in topography ar ground surface relief features? . . . . . . . . . . ?C
(d) The destruction, covering or modification of any uniqne geologic or x
physical features? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(e) Any increase in wind or water erosion or soils, etther on or off the site7. ~
1
(f) Changes in deposiLion of erosion of beach san s, or changes in siltation,
deposition or erosion which may modify the cha nel of a rtver or stream
or the bed of the ocean or any bay, inlet or nke? . X
Exalanation• ~•Cb~ oVevGc~vCv~~vsc.~ p~ Sotl 46 c.f lout LG.iv~.a IP
pioy K. 1 V% ci ! 01" ~10Q~ vI v%C
2 Air. Wi11 the proposal result in: Yes Maybe No
(a) Air emisstons or deterioration of ambient air quallty?. . . . . . . . . . . . 14
X
(b) The creatlon of objectionabte odorst . . . . . . . . . . . . . . . . . . . . .
(c) Alteration of atr movement, moisture or temperature, or any change in
climaLe, either locally or regionally?. . . ~ . . . . . . . . . . . . . . . X
Explanation- Z? V~Ew
.
_ C/
3. Water. Will the proposal result in: Yes Maybe No
(a) Change in currents, or the course or dlrection of water movements, x
i n ej ther mari ne or fresh waters? . . . . . . . . . . . . . . . . . . . . . .
(b) Changes in absorption rates. drainage patterns, or the rate and
amount of surface water runoff? . . . . . . . . . . . . . . . . . . . . . . . X
(c) Alterations to the course or flow of flood waters?. . . . . . . . . . . . . X
(d) Change in the amount of surface water in any water hody3 X
(e) Discharge into surface water, or in any alteration of surface rvater
guality, including but noLlimited to temperature, dissolved oxygen
or turbi di ty? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(f) A1Leration cf the direction or rate of flow of ground waters? X
(g) Change in the quantity of ground waters, either through direct
addiLions or withdrawals, or thraugh interception of an
aquifer by cuts or excavatians? . . . . . . . . . . . . . . . . . . . . . . . ~
(h) Deterioration in ground water quality, either through direct
injections or through the seepage of leachate, phasphates*
detergents,waterborne virus or bacteria, or other substances X
into the ground waters? . . . . . . . . . . . . . . . . . . . . . . . . . . .
(i) Reduction in the amount of water otherwtse avatlable for
public water supplies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
2
~
, ! .
Explanation: 3. (6) GJ t~e 14,ov4i e°- CO Svv40bGe Wle?Q✓' Vv"-dff
on ,
~,~Tc~ ZUv v P.oS ►
I 4. Ftora. W111 the proposal result in: Yes Mjbe No
(a) Change 1n the diversiLy of species, or numberlof any species of
flora (including trees, shrubs, grass, crops, microflora, and
aquatit plants)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(b) Reduction of the numbers of any unique, rarle or endangered ~
speci es of f1 ora? . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . .
(c) Introduction of new species of flora into an krea, or 1n a
barrier to the normal replenishment of existing species?. x
(d) Reduction in acreage of any agricultural crop? . . . . . . . . . . . . . . . . _;K
Explanatlan: S. Fauna. Will the proposal result in: Yes Maybe No
(a) Changes 1n the diversity of species, or number of any specles
of tauna (blyds, land animals including reptiles, fish and
shellfish, benthic organisms,insects or microfauna)? . . . . . . . . . . . . . K
(b) Reductlan of the numbers of any unique, rare, or endangered x
species of faunal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c) Introduction of new species of fauna into an area, or result X
in a barrier to the mlqratlon or movement of fauna? . . . . . . . . . . . . .
(d) Deterioration of exlsting fish or wildllfe habitat? . . . . . . . . . . . . . x
Explanation: .
6. No1se. Yes Maybe No
(a) W111 the praposal tncrease existing noise levels? . . . . . . . . . . . . . . x
Explanation: Gw) ro5s, lolC w++ vio&.- Ivt tv.tv Se- iu+ Tvoapt c. tiv I Se
ct u e ?o ~o•o.~ ~c c~ lc~"~'S .
7. Li4ht and Glare. Yes M_aybe No
(a) Wi11 the proposal produce new light or glare? . . . . . . . . . . . . : . . . ~C
Explanation: J X44:rn &J
8. Land Use. Yes Ma ►be No
(a) Will the proposal result in the alteration of the present or
planned land use af an areal . . . . . . . . . . . . . . . . . . . . . . . . . X.
Explanatian:
9. Natural Resources. w111 the proposal resvit in: Yes Maybe No
(a) Increase in the rate of use af any natural resources? . . . . . . . . . . . . )t
(b) Oepletion of any nonrenewable natural resource? . . . . . . . . . . . . . . . ~
Explanation: In e--oTi
~
T+
10. R1sk of Uoset. Does the proposal involve a rlsk of an explosion or the Yes Ma be No
release of hazardous substances (lncluding, but not limited to, oil,
pest9cidess chemicals. or radiation) in the event of an accident or
upset condi ti ons? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
~
Explanatlon: .
~
11. Po¢ulation. Wi11 the proposal nlter the location, distribution, density. Yes Maybe No
ar growth rate of the htianan popul ati on of an area~ . . . . . . . . . . . . . . . .
Explanation: ~ ~ .
12. Nou_stng. W111 the proposal affect existing housing, or create a demand for Yes Maybe No
idditional housing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
X
Explanatibn:
13. Transaortation/Circulation. Will the proposal result in: Yes Maybe No
(a) Generation of addttional vehicular movement? . . . . . . . . . . . . . . . . X
(b) Effects on exi sti ng parki ng faci l i ti es, or danand for new parkt ng? K
(c) Irtvact upon existing transportatlon systems?. . . . . . . . . . . . . . . . X
(d) alterations to present patterns of clrculation or movement
of people and/or goads?. . . . . . . . . . . . . . . . . . . . . . . . . . . X
(e) Alterations Lo waterborne, rail or air trafflc? . . . . . . . . . . . . . . . x
(f) Increase in traffic hazards to aator vehicles,
bicyclists, or pedestrians? . . . . . . . . . . . . . . . . . . . . . . . . . X
Explanation: I b~ ~ ~tc?Z►T tv►cv-p*b S<p
~L cxo sT To U_C&V pv Y1c.• Kj oo vcoLj
14. Aubiic Serrrices. Will the proposal have an effect upon, or result Yes Maybe No
~in a need'lvr new or altered governmental services in any of the
folla+ing areas:
(a) F1re protection? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~C ♦
( b ) Po11 ce proLecti on? . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(c) Schoolsl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k
(d) Parks or other recreational facilities? . . . . . . . . . . . . . . . . . . . ~
(e) Malntenance of public facilities, including reads? . . . . . . . . . . . . . . X
( f ) Other govenvnental servi ces? . . . . . . . . . . . . . . . . . . . . . . . . X
Exclanation: w•~~ vI v-e, vti eu.,P f i14 qcl v--* •.4-
W 1 l.L 0ERDdj~~
15. Enerc%. Wi11 the proposal result in: Yes Ma be No
(a) Use of substantial amounts of fuel or energy?. . . . . . . . . . . . . . . . ~
(b) Oemand upon existing sources of energy, or requlre
the development of new sources of energy? . . . . . . . . . . . . . . . . . . X
Explanation:
a
J
~ .
• ~ .
16. Uti l i ti es . Wi 11 the proposal resul t i n a need for ngw systecrs. Yes Maybe No
or alterations to the following uti11t1es:
(a)Powerornaturalgas?..••••••••••••••••••••••'••••• x
, .
(b) Camwaication systems? . . . . . . . . . . . . . . . . . . . . • . • • • • • . X
(c) Water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(d) Sewer or septic tanks? . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(e) Storm water drainage? . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . x
(f) Solid waste and disposal?. . . . . . . . . . • • • • • • • • • • • • • • • • • • x
Ex lanation: l~0 4'~ I* ~,1 c. T♦a " k-, ~ cA r-.* e.•~cL v~ 99MCA
~
~
Yes laybe No
11. Numan Health. will the proposal resutt in the creation of any health hazards ~
or potentiaT health hazard (including rtEental health)? . . . . . . . . . . . . . . . . ~
Exqlanation: Yes y Aabe No
18. Aesthetics. Will the proposal result in the obstruCtlon of any scenic vista or
v/ew apen to the public, or witl the proposal result in the creation of an
eesthetically offenstve site open to publlc view?. . . . . . . . . . . . . . . . . . K
Exvlanation: Yes Maybe No
19. Recreation: Will the proposal result 1n an impact upon the quallty or
quantity of existing recreatlonal opportunitiesl . . . . . . . . . . . . . . . . . . JC
Explanation: .
Yes Ma~,be No
20. Archeoloqical Historical. Will the proposal result in an alteration of a
slgnificant arc eotogfcal or historical site, structure, obJect or building? X
Explanation: ~
I
i
I
tII. SIGNATURE
i. the underslgned, srrear under the penalty o~ perjury that the above responses are made
truthfully and to the best of my knawledge. I alsv understand that, should there be any will-
fu1 misrepresentation or willful lack of full dtsclosure an my part, Spokane County may with-
draw any declaratton of nonsignlficance that it miyht issue in reliance upon this checklist.
Oate: ZJ AkoLj 64 Propdnent: 14•IP. C!n va s'T Cv ~ vt C.
•
(Please Print or Type)
PropoAieet: ~~P G In v- i ST~ Ce-> 1 H C. Address : w+ ►1 T~Jy1
Phone: 'aN ' 1B50
,e~Z' ~~G~ J--*hone: Qate:
Person compl eti ng forn~:
~ ~►rc,l., 1TQ c-'
FOR STAFF USE ONLY
~
S taff Member(s) Reviewing Checklist: Based on thls staft review of the environmental checklist and other pertiment informat ~ statf:
cz~
A._,)~, Concludes that there are no potentiatly significant adverse impacts and recomnends/issues
a proaosed declaration of nonsiqnificante.
8. Concludes that potent1a11y signiflcant adverse impacts do exist and reconmends/issues a
final declaration of siqnificnnce.
1
C. Concludes that theie are no potenLially significant adverse impacts and, because of the
nature of the proposal, recomnends/issUes a final declaration of nonsi4nificance.
i J
.
Ised: au9ust, 1981 5
•
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