Montgomery E 11508 Off Premise Sign
. •
~
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNOERSTANO
(Ptease return thts orlalnal and your bullding plans to the Department ot 8ulldln9 ana Safety)
,~e .
1 Ownor e Nitm pest) nl►el) (m) ~ pe¢artment tbe Only
/.'7 Ras Comm
2 Roject /lddraM 00 Mafling Addreae) a Neme Spaae ZiP
Ag'
~
s u,caomm~ly suadIviefonra at ame oS~-f~L.~ ~~oL7b v~9~ s
4011
1 f~lp L.~t 8b~k
O S * f• OEPARTMENT USE ONLY • i•
~
g Cab Z" qct Prole¢t No
• Towsr
6 Dwell/ No ot6ulfOfnpa Sp Ft IAore Oepin Frontage
7 80! Bealc-Front (L)8-1 (R*2 Rv Carma Traai Module Ma Iniflale
* 18 ArohHea Fhm Nana 8ireet Address ~
~
ap / j qq 6h" Phone
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OGRtYCI ftrmrI r r Phmi61} dIHeBnI ihlUlBbOVe
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Gbntrar.tor Flnn ~ 8Veet Address '
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qy Sude Phene
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Ltosn~e Pfmr~e II dit erent lhan ebove
04
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8 OwnerlApeni (tr auferent ihan 01 aoow) Businea Address
~ D oty S1ate Phone
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4 RwliWkmquWad (Y/N) Other (Y1N) SEPA Exempt (1fIN) Date
15 Type Weotk 61slp Cd MH Ci New n Reptaoe t"i Olher
C Flre C? pemo i AOdlAtter r Move
00
» oewtbework r
10 ApP11cent Neirne 8t►eat Address
11 Zip pty Stnte Rhane
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* Lsndor Street Adarees *
ZID Gty 8tete Phone
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contact pOMn Phone rtdIffereM Ihan abave
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AddI t lonal I n f atmat ian
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- DEPARTMENT APPROVALS
This is not a Permit
Applicatlon Type ,
(Standard untess (Indicated approvels required in either release or "release wlth condltlons"
~athervvlse Indicated) 8pace prior to permK issuance Fast Track Release
Eerly Start Release wlcond 1 Hotd 2
❑ Emrironmental Heaith C'7 Commerclal CI Resldentlal
W 1101 College f_1 New Conatructlon 0 81ag alteration/aCditlon
Room 200 O Addltional afructure '
APPLICATION 0
ConditionslComments ~ Plannine/2ontng iCI Commercial ~O Cert of Exemption O Frontage ~
r ~
~ N 721 Jefterson O Setbacka, D Iot wld, D lot elze 0 uselzone 95
O CU variance zone change ahareltne, O fence
O r
Con0ltionBiComments
~ - .
~Eng~neers p Commefclat Cl Residentlal 0 Flood Plain ~
0 v4v
, N 811 Jefterson D drelnepe ❑ new acceaslepproach, ❑ ience
O road improvementa
ConditionelCommente
~ uuuaes
N 811 Jefterson
►
Cortdttions/Commenta
❑ Qew ~
❑ Pfan Exam ~
Fire Prev ,
Conditions/Comments
, Project Aepresentattve ,Telephone
Agenclea Pertorming Speclal lnspection
~ c 1 _ .
Y O
H E 2 .
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3 1 Indkate above ar aitacA condittona reletlve to floiel es pullt epprovsl
. 2 Irtdkate aboYe or ettseh reaaons for holc!
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404l449-75+00
CQ ~ iN~ RGIA 30136
pf's ME'T pv~,UIt~. ~E°
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6 30 •?9 Rq pD
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(THIS IS NOT A PERMIT)
BUILDING PERM{Y APPLiCATION WORKSNEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS 4F THE FORM YOD UNDERSTAND
COMPLETE !N INK
(Please return this original and yaur buitding plans to ihe Deparlment of Building and Sateiy)
SHAOED AREAS ANE FOR DEPARTMENTAL USE WoIW Numbw ~
Owner 3 NBme L T' F1RS1 T ~ M1
Praded Addre9s (Street Name 1:~AZEWI;y ~p
1/7 oyq
a-fo 9 ey
App,,ca,t ~-~#91 r~~
C,ty ~ State _ / ~ Z'p^ Pf'°ne
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Businass Phone
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contracta/Agent Aa7)11 00
- 5A7 ~C'itY State Zip Phone qa96
COntad L,Fccns6 (vumUer fRequirea) Busrness Phone
NM+tect/Enpineer
kw? r4d ~ ~2 .01~~'a~r rcw 1~ ~ C~ty State Phone
l 1 CoMect 8ustnes9 Phone
l !
Umder Aadress .
qtr State ZiP Phone
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Res Comm
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~t,►~atontPl~t t~te~me1stimt Pl~7t I~umber
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Asmmmr ft pgJ Numbw lat BtOdc Wat Nurnbet
~q 5,;[-1 ' o> t.%~
P~ertlfbtlt Fl~e N~ Zo^e/ Comp Ptan C+e►sus Tract
~ I Y~
~t~tmb~tplpwe~tlbeD(!nile Numberof 8ulldihga I.at Slze (Sq ft /Acre) QeOth ftontage
lLqV $etpaakc-~t.~y Ley $gtbaCk RigAl Set08Clt Raar Selbaclt RJW 1N1dlh
SquelB fOOtege
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" , T~ De1e Group TYD@
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, r 73
DEPARTMENTAL REVIEW
- ~
Approved Apprond
oval Hoid
Envtronmentei Heelth Appllcatlon p
❑ W 1101 College
Aoam 200
~ PlenningJZoning
N TZt Jefferson
aze
4 `,,d9
e elt~,.,,,~,~`~ , ,
~ineen
~ N 811 Jefferson r-0i=o 2vmmt oQ ~ ~
Utllltles
❑ N 811 Jefferson
-
Plan Resrlew/Flre Preventlon
~ N 811 Jefferson
. ~ ,
Other (SEPA/CNNeaI Meterlml/ote j
❑
~
❑ Fast Track/Spee:let Inepedion Inbrmation
ti
ProJect Repmentative Phone
Address
1 certtfy that 1 have examined thts appllcailon and atete that the informatlon contained In H and submitted
~ Dy me or my ageM to complle eaid application Is true and correct '
SIQnature . Date
~
`
,
~ BUILDING PERAAIT APPLIC14TION WORKSMEET
PLEASE PRINT AND COMPLETE ONLY THOSE PART3 OF THE FORiVI YOD UNDERSTANO
(Please return thfa ortplnal and your building plena to the Department of Building ertd Safety)
I
t Owner a NWM past) ttlrotl UMl OepeRment uee Onty
. 'Po 5 t F L 1,dg IT G4'✓/ ~ ~ Comm
h Z Plqecl Addroes (no1 Malling AOdroee) or Roed NBme som Zip /
4~5 //.61o/ A)aW1,01410mer v /k,"Z) ~`~2 0 6
9 Gly/Gberenunity 8tate SuOdtvtBtonlPlat Neme
~ 5po 1:pd / A14AQn,-Or,JA/
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4 Aneeeor No lo! 81aaic
o S C7 SI / * * • DEPARTMENT USE ONLY * • •
n
s act e Zare arow No ~
8 OMieRI• ~ No otBultdinge SQ Ft IAcm pgpM ~u
ntap~
~
7 8ot BedaF"nt 0.I8-1 (iy8 2 Rm Omew Traat ~ Modute No IMllate
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• 18 ArahiDeCt Flrm Name 8ited Address
~ Dp atp 8tate Wrone
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R Oo*d Plareo~ PRone II dtMemtt Mon above
l !
~y W w eiiA R(1„ M" ~ SV" Addrew
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Ziv ary ' scm wrone
~ cwftoc Fbrao„ uMWNo. vNone u QlKen~sn amabore
Omw/Agant (ft dtlfarortl lRsn 1" aDavv) B+utnow /bdnm
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~ B ZIA oh ~to PNom
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12 Rsview Requlrea Plan pieclt (YIN) WAm i1flNl 6EPA ExeenpIl (YlN) Q~b
~
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~ 16 ZYp9 W" 8NO MN O Now C7 Rsploos O Ot1~er ,
~ 0Rre i] Oenno _ L7 AddlAttar ~ Move
~
14 Deaa►M9 WtIk
' y locj4lon o.Aee-iw&r& e hon
~ w ;;;mrn tam MmM a&rsse
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.11 Zlp GtY 8teA8 Wlone
1 1
Lerder 8treet A~ddr~e ~
7ip pry 8tste Phor+e -
1 )
contact Pwaon ' Plmre It alfterent mmn above
1 1
Additlortat infamattcn
~ - .
4
~
d ~ ~ ~ DEPARTMENT APPROVALS 46
~ This is not a Permit
Appllcation Type
(Standard unless (Ind{cated approvate raqulred In elther "relesee' or •release wlth condltlona' ~
otlierwlee indlceted) space prior to perm{t issuance
Faet Traclc '
Eerty 3tert
~ Release wlcond 1 Mold Z 2
,
~ 1-3.t ~ Eevlronmentel Healih p Commercial Yj RealOential '
W 1101 College O New Constructtan O 81dg etteratlon/addition ~
Raom 200 C7 Additlonel atructure ~J
p- APPLICATION #
Condltlona/Comments - ~
I:v
pinning/Zonlng 25'6ommerclal, O Cert of Exemptton O Frontage,
jg N 721 JeNereon 13 8eiback9 O lot w/d O lot elze C] use/=one,
t
O CU, varlancea xone chanee ehorellne Q fence,
29 Other J--
~ L 1,8E ~Q R10 -
CondttionslCommenta ..1'929
t
~ y❑ Enpfrwra 1w Commerclal 18' Reetdentlal, O Flood Plaln
N 811 Jefferson 0 draJnage O t►ew acoessJapproach 0 tence J ,r - D road Impravementa ~
OOnditions/Commente -L~~ ~/B.~~P ~ ' lq
~ -
A
-/'W A, 0 J, I
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O a~
r~ uuueies
,,N 411 JQff6f$Of1
Candhiona/Comments Z-~
~
fl oow ~
P14n Eimm
~ Firo Ptev
~
oloOl
Candluorts/Commente
~
~
Project Representative .Teiephone
~ Agencles Performing 8pecial Inapeatlon
~ .
~
1- E Z ,
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1 Indkate ebove or atfaeh tondlUona retetive to Ilnal as bullt npproval
2 Indkate tbove ar ettach reaeons tor hold
a
.
INN
BUILDING PERMIT APPLICA?'ION WORKSHEET
PLEASE PRINT ANO COMPLETE ONLY THOSE PARTS OF TNE FORM YOD UNDERSTAND g ~
~
(Please return this orlQlnal and your building plens to the Oepartment of 8utldtn(i and Safety) ~
,
r
1 Ownw s No" pa$t) - p►at) fm) Oepartn~+t tJ~Only
~D 5 rGL ul~ / ~ L ~ ~ ~ ocmm
Z Projea! Addraes Irro1 Meiling Addreeal or Rnd Nams sPWO Zlp' s
o`
4 ~ 5 //~Df IPI.~ /a 92
3 GtylOontmtmlty SZate Subdivl8ton l ilet N8m6
S1-e'0 kwr~~
♦ Aseeaeor No ~
~ ✓ s ~ ~ Lot 8lock DEPARTMENT USE ONLY * ~t * ~7
~
' s 2bna ace r Z" Pr+o{eat No
8 Dwatl0 NO of 8ulldlrtp Sp Ft IACte Oepth Fronta~9 f
7 gWBook~ (LS.1 tql8-2 Rear Cmus Traaf Ntoaule No Inltlata
,
18 /IrcNteo! Flml Nsme 8treet AdJreB9
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~ Mp Cfly 818te Phone
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S 4tl ~ftd pow Phf10 It QjffQwt u19fl ob o ~ jwm~
OzoacM AfRI Rafll0 StroM AdQfom
~ aP pty ~e PAate
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Uaenmp.llp r PAow II dtltwenf lfm ebore s
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8 ownerIaWn! pr diftweit man 01 abo+re) Suebme Amaraes
~
8 Zip city Stete r PRa18
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12 Revtew ii9qultsd PlBn Gteck (Y/N) Othw (YlN) BFPA Ex81tip1 t11/N1 Oata
i
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~ f 16 Type Vvwk 8lQA 0 MH O New C] Repboe O!l~er
❑ Fire o oemo n aae/aea
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14 oesm+Wvvo~ , e, loC
(:~1
~ ,o Appiicent He me saM nedma
~
11 z+p ary swe PhOne
~ 1 1
• 8traot Addrea e
LartNr
Lp Gty State r Pliorro
( 1
Contact Pww ~ PhoAe ft dNtetenl tn8n etave
( 1
Addltional Inforrnallan
~ ~ ~
L
' J sDEPARTiVIENT APPROVALS
This Is not a Permit
~ Appllcatlon Type
(Standard unless (Indtcated approvals requlred tn either "release' or "release with condltiona'
otherwise indicated) epace prior to permit lesuence ) L ,
Fast Track
Early Start Release
ReIeNe wlcand 1 Nold 2 `
0 Emvironmental Neelth D Commerciel O Residentlal ~
W 1101 Coilege p New Conetruction+ p Bidg elteration/addition
Room 200 11 Additfonai a/ructure 'SpI
~l
APPLICAT40N 11
1 I ^ ~
~ Conditlona/Commente
0 Planning/Zoning wCommerclalt ❑ Cert of Exemption O Frontege,
~ N 721 Jefterson O Setbacke O lot w/d C] lot slze O uselzone,
[I CU varlance zone change shorelirte O fenae
O Other
` GondittonslCommente
z~QQ
~ t
~ E.ng{neoro _X1c'Commercielf O Residentlal O Fiood Plaln ~
N 811 JeNerson ❑ drelnage O new sa~ee/approsoh. O tence
~ a
❑ road improvemen ~
CandttlanelComment8 ~ a
:
A~ ITkc
uauues
N 811 Jetferson y
OondltionsiCommenta ~ A/ A.01 X
~
3 ~
b ~ ~ T
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Oew - ~
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P1sn Exam
Rre Prev
~ Condlttars/Commente L
~ B
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~
~
~
=
~
`0 ProJect Representative i Telephone
~ Agencles Perbrming 8pecial Inepection
~ o ~
~
2
~
~ c
3
1{ndkets above ot attwh condlitons relolivo to ilnal as built approral
2 Indkete ebove or etiech reaeons tor hola
BUILDING PERMIT APPLIC14TION 1NORKSHEET
1
PLEASE PRI NT ANO COMPLETE ONLY THOSE PAATS OF THE FORM YOD UNDEASTAND ~
(Please return thie original and your bullding ptana to the Oepartment of 8uilding and Safety)
t Owner e Naune I~t) (firet) Omf Obpertment tbe Onty
I-G~uJ.9i~
2 (n MelliAddr888)or Roed Neme S0~ ~R 7/A7ddrM
~
s' aty/odrumMrcy , 8tate sUbeivlaton►wae Neme
~f'o h AI
. ~ Pbf~ ~ i Lot Block
ofs V : a * * OEPARTMENT U8E ONLY t r *
~ a siccxb ns Aat d Zone Pno)eat ko
z
~ 8 pwetl r No of 8ultdlnpe 8q F! IAaro 0e0h i~ro~tsge
~
7 8et 8ack-F~oM U-3~~ (R)8-2 Rear ComusTreo1 Module No Initiab ~
~
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18 Atdtlbecl Ftmn Nams 8treet AOdram
.
ij4 ziv a ry • Stow Fhm
1
~ p~pn I r Phone lf dlffemM t1m abcti'b
ON t rA Am Nams 80+e0 Addram J
Cik
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ZP (Iry Phm
" Oo~taat P~son Uoertae No Phons It alitarent than Mo+ra
8bM~e►fitt Qf d?lt~erm~i ihan Ot above) ~ BueMeta AQQneae
S Zvr ary
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~ 12- RaNBwNepuUeO ~ 71 Qtook(Y/N) Olho►(fIli) SEPAEaomst(YIN) OeN
*n
~ lt ts TYp,avh* BtdO O MN O New t] Reploos D Ot11v
oFire o oemo Aoaiater omme
14 Oewft ~
/ n Lem
w t~l~ ~t -6,6c- - n
wd~ c
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r ap aer stow pto+s s
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. Lande, sir" aaoroeo ,
AMa aly gtate ' w+ono
l ~
contod paroon r - P4ron8 If dlHerent tAen aNa0
I 1
AddItional Intormation
~
A.
~ •
DEPARTMENT APPROVALS
This is not a Permit
Appitr.atton Type
(Stendard unteas (Irtdicated approvals required In either release• or'retease with conditlons•
` otherwlse Indtcated) apace prlor to permit issuenoe )
, ❑ FaBt Track . Rat
Early Start Release w/cortd 1 Hold 2
Environmenfal Health I
Commerclal p Residentiel
W 4101 Colleee O New Conetructtor► O 91dg alteretianladditlon
~ Room 200 O Additlonal atructure
~ APPLICATION N '
r
Condltlone/Commenta -97"f) ~'~~~,(f~~ ~ doonbr
~ ~ehleh
1&;; A L- ~
~ ti ❑ Plannlnp/Zonirtg Commerclal, ❑ Cert oi Exemptlon O Frontape, ,
}N 721 JeHereon O Setbaaks Q lot wld 0 Iot alze 0 uaelzone '
❑ CU, verienoe, zone change, ehorellne O tertce
O OtAer '
Qondlttons/Commente 16d" Gaeal V"11EG
4 ~
EnOtners 2 Commerclal O Resldentlal, O Fiood Plaln, ,
N 811 Jefferson O dralRage 13 new accsselapproach O tence `
O rQad roveme te '
C~dlttona/Comments ~ 4011S~ ~~5 &Z,D LdT~p
l '
~f
~ uutttum
~ N 811 JeNarson `
~ CatdNlorts / Commenle
}
t OlLE
3
~ D od.r ~
~ - ~
1 ~
j
~ 0 .Ptan Emm
i Ftm Prow
~
~ Qartditlons/Comments
°~"~,CE
~
CIL
.
iD
Pt+oJect Repraeentative Telephone
I Agencles Performinp Special Inapection
~ E 2
~ c
3
~
1 Indkate above or attaoh coRditlona ro1oUve to tinal at bullt epproval
: 2 Indkats above or ettech reaaone for hotd
,
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~u11t iet ~~~r,Pn I IIic. Bubiness Name PGv~.1
Add re5s A,ddress E
Phone Phone
~
County Conract Yerson Phone No 456-3600
CAP1Mh.RC IAL 8U [ LUI NG PERM tT ttEV ILW
This building permLt review is intended to appraise you oE the impTUVemente (roadway, side-
walk, cucb, stnrmwateT, etc.) whieh mus[ be constcucted ia association with your building
permit This checklist will be filled ou[ hy the Engineer's staff and a copy will be re-
[ucned to you ac the time that the permft is initialed by the Engineecing Department. All
requirements shall be completed prior to iasuance of the building permit. All unchecked
boxes require addi[iortal research or information to make a determina[ion
I Stormwater Draina e Considerations
~ Per guf~eeT~neor 'Stormwater Management 1981 ' both on and off site.
1. 208 Conaiderations* ~ Yes ti No
2. Flnod hazard zone considerations** ~ Yes ~ No
3. Storm llrainage Plan ~ Yes ~ No
Ii Planning Action # :Z e / 6
1. Rezone, Conditional Use or Variance on property ~ Yes ~ No
2. Are requiremente of planning actioa incorporated ~ Yes ~ No
into site plan
III. !jght of Way
1 Does permit necesaitate R 0 W. dedicatioa a Yee ~ No
2. Did zone change require R 0 W. dedication ~ Yes ~ No
3. Rad ius at corner ~ Yes ~ No
IV County Road Improvements
1. Roads need to be improved. How wide ~ Yes ~ No
2. Curb ~ Yee ~ No
3 CR P/ RID agreement (Copy of deed, con[rac t, oc a Yes ~ No
title report required.)
4. Plans for improvements provided ~ Yes a No
5 Sidewalk ~ Ye8 a No
V. Parking Plan 6 Approach Location
1. Review and sign of f by 1raf f ic ~ Yee ~ No
2. Approach Permit from EQgineer's Office Yes ~ No
3. State or City sign off ~ Ye8 ~ No
4 Is this road on 6 Year Plan ~ Yes ~ No
Vt ULIU Agreement ~ Yes ~ No
VII Field Review Preliminary Comments
* Alt lAnd within the Aquifer 5etibtttve Area, wliere deemed feasible by the County Fngi-
neex, shall tncorporate stormwater treatment ta mitigate the potentfal for graundwater
degcatlation (See Guidelines for SCnrmwater Management 1981, Spokane Baard of County
CAmmissioner's Resolution NA 80-1592, as amencieti. )
Ttus Ms,rpu~e ot fload hazard Zone rNView Ls to mintmize losses due eo f tuoding in spe-
ciFto areas destgna[ed hy Ftoad Ha7ard Boundary maps on file at the ('ounCy Rngitier-r'S
OE r i« c:. (q(-e SpUkane 13oard of ('ounCy Ginnni ssioner's ResAUit ton No $1-026, as
am► ,id+,d
)
. ~i"i~