2004, 04-27 Permit App: BLD-04-04202 Residence BUILDING PERMIT APPLICATION WORKSHEET
CI CITY City of Spokane Valley Community Development Department
tie Building Division
ey. • •
11707 E. Sprague Avenue, Suite 106
Spokane Valley, , 99206
Phone: (509) 688-0036, Fax: (509) 688-0037
-
REQUIRED SITE INFORMATION.• ••
Street Address: /4 to`f .E `P
Assessor's Tax Parcel Number(s): .4/3:243, /O/
•
Legal Description: SER G's-an/5 .s/3 AT / ,8. k" /•
PERMIT DESCRIPTION: /✓ELc1 ,fDnn;E . •
Building Permit ❑ Change in Use El Grading ❑ Manufactured Home
Li Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: 7),c1( "4,9-4..p", ❑ Applicant: C Rk 4 rw ea,o s
Phone: 9.22oyay Fax: • Phone: 9.741-15-1,8 Fax:
Address: ///7 itl. .evElz�wl flA Address: .C./44:4/ "HU'•fvE
SPD. vAu.EY hd.44. 992/4 •• .5P e. j, ii j(y 1.4A4 ?90 37
City . • State Zip Code City State Zip Code
❑ Contractor: CRE,4-/vx Co....s r, •❑ Architect: AadEPk,tJo,E.vi MrMpE 6606.)
Phone: 92z j.53-7Fax: 9�z 9,347Phone: yss-7,sFax:
tivL
Address: , ',/W..20 ...2 y '—'11 v4. L i -- Address:
.SPa. vd r.<.EY w.l. 79 3 7
rie
City State Zip Code ;5 City• - State Zip Code
WA State Contractor License#:('g 4TG/2 i,2_ ea Contact: ,r/An. --7-Ro77.
• PERMIT/BUILDING INFORMATION .
•
HEIGHT TO PEAK ..zO O'„ DIMENSIONS: #OF STORIES:• . / .. .
MAIN FLOOR TO SQ. FTG:/,/3 2""FLOOR SQ. FIG: �/� UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FIG: GARAGE SQ: FTG: :• 5-..5--ZDECK/COV. PATIO SQ. FTG:
.//A
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: 6/16-
Lc.>oo D
.. #OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
3 /6/3
COST OF PROJECT: • — 30%SLOPES ON PROPERTY: 'SEWER OR ON-SITE SEPTIC
/4-400 SYSTEM? .Ee4140Z-
MANUFACTURED HOME
•
Width.; Length: Year:* Pit Set:
Manufacturer: .
RELOCATION
Previous Address: •
•
Proposed Use:
FIRE SAFETY •
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: • Date/Time:
Valuation: . Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address: . •
City State Zip
. • Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE • ❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone:. Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of`Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
•
•
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 0 Check 0 Mastercard . ' ❑ VISA • ❑ Other
• Bankcard #: Expires: VIN#:
•
Authorized Signature:
MECHANICAL PERMIT APPLICATION
TY ig-1*Mane City of Spokane Valley Community Development Department
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
4.00
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: Permit Use:
Owner: view .v, ,4.14,7 E Phone (Daytime Contact):
Mailing Address: Ai. ///7 &vE2G,21 EA/ Rd_ .5Th. L MLlai`' l�J.l 9316, 37
City State Zip Code
Contractor: CR,(44-?)riFF Cd '7 License#: & /1/2ic)Phone#: 22 ASST
Mailing Address: ,,E. /y4/_26 2y 1st/ Affif_. SPd. l..1.1-41-44-' z.c/4 99c1 37
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK _ UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 / X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 =
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 X $50.00 =
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 =
13 RANGE X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER / X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) X $1.00 =
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS X $10.00 =
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM , X $12.00 =
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $19.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD -X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 =
26 AIR CONDITIONER 3-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 -=
29 AIR CONDITIONER More than 50 TON X $60.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
❑CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION
Spokane City of Spokane Valley Community Development Department
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: Permit Use:
Owner: 4p,c4.< M A Ld A/A— Phone (Daytime Contact):
Mailing Address: N. ///7 4E1.,ER. .FEN R&. s20. LMLLEy /did- 992/6
City State Zip Code
Contractor: G'/2E, r>LIL 27 , er/OA/ License#: CR,4re i 212 Lhone#: 92 2 6637
Mailing Address: E. /4'4'94 Ay Z` , tvE, SPA. vitI.LEs, &JA. 95170-7
740 T;Jy State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 TOILETS 2' WATER CLOSET,BIDETS / 3 X $6.00 =
2 URINALS X $6.00 =
3 TUBS Z Z X $6.00 =
4 SHOWERS(PER TRAP) / BATH,STALL,ON-SITE BUILT X $6.00 =
5 SINKS LAYS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, 5" X $6.00 =
5 JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER / / X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, .3 X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE: I
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Call 24 hours before inspection required
Sôkane Phone 509.688-0195 Fax 509.688-0037
.0,00Valley
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit# 04-287 Account#
ROW CONSTRUCTION PERMIT
Location of property 14426 E. 24th Ave.
(Address/Parcel#, if available)
Applicant Name Creative Construction Fax
Address 14420 E. 24th Ave. Spokane Valley,Wa. 99037 Phone 509-922-6557
Contractor's Name
Address Phone
Contractor's Reg.# CREATC*1212W Expires 5-22-2005
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection ■ Driveway
❑ Curb &Gutter El Gas Installation/Repair
E] Cable/Conduit/Pole Sidewalk Repair/Construction
Water Installation/Repair Other
111 Pavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond#
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved Date `÷--3
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Signature
Fees Paid$ 25.00 25.00 Date !nit
(Application) (Inspection)
In addition to the permit application fee of$16.00(utility)or$25.00(construction),inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(Signed) Date
Permit not valid until One-Call Notification Ticket#entered here
PERMIT MUST BE KEPT ON SITE
,
DEPARTMENT OF COMMUNITY DEVELOPMENT
CURRENT.PLANNINGjDIVISION
CITY
pokane
STAFF REPORT.-M.,- ....--,-
ND NOTICE OF DECISION`
valley ,, ,,- , ..,.- ,,,-,„, f. , -
FILE No3 -A:-A6704
:,
;.,,,,.,:.; ,,„.: _c .::.,_ r
4.00
STAFF REPORT DATE: April 21, 2004 City of Spokane Valley
DATE DECISION MAILED:April 21, 2004
PROPOSAL DESCRIPTION: BLA-10-04. Request for boundary line adjustment approval between Parcel
Nos. 45263.2101 and 45263.2705. The applicant requests approval to adjust the southern lot line of
Parcel No. 45263.2101 by moving this lot line north by one hundred and seventy-one (171) feet
thereby reducing the depth of Parcel No. 45263.2101 by one hundred and seventy-one (171) feet and
reducing the total square footage of this parcel by 19,152 square feet for a revised total lot area of
16,484 square feet. The depth of Parcel No. 45263.2705 is proposed to increase by one hundred and
seventy-one feet, and the total lot size will increase by 19,152 square feet or 0.44 of an acre to a total
lot area of 100,223 square feet.
PROPOSAL LOCATION: Parcel Nos. 45263.2101 and 452t-3o.
5263.2705 further identified as East 14420 24th
Avenue located between Best Street and Adams Street on 24th Avenue in the southeast quarter of
Section 26, Township 25 North, Range 44 East, Willamette Meridian, Spokane County, Washington.
PROPERTY OWNER/APPLICANT: Jim Trotter, East 14420 24th Avenue, Spokane Valley, Washington
99037
APPROVAL CRITERIA: Section 12.100.110.d of the Interim Spokane Valley Subdivision Ordinance; and
Chapter 14.616 (Urban Residential 3.5) of the Interim Spokane Valley Zoning Code.
DECISION: The Department of Community Development, Current Planning Division, after review and
consideration of the request and applicable approval criteria grants CONDITIONAL APPROVAL to
BLA 10-04.
STAFF PLANNER: Karen E. Kendall, Assistant Planner, Current Planning Division, Spokane Valley
Community Development Department.
ATTACHMENTS:
Exhibit 1: Vicinity Map Exhibit 3: Existing and New Legal Description
Exhibit 2: Application Submittal Exhibit 4: Proposed Lot Consolidation Map
Staff Report and Notice of Decision for BLA-10-04
April 21,2004
1 of 4
I. BACKGROUND INFORMATION
PROPERTY INFORMATION:
Size and,Characteristics: . Parcel No. 45263.2101 is 35,636 square feet or .82 of an acre.
Parcel No. 45263.2705 is 81,071 square feet or 1.86 acres
SUBJECT PROPERTIES&SURROUNDING COMPREHENSIVE PLAN,ZONING AND LAND USES:
Subject Prop i, s iComprehensive Plan— Low Density Residential
Zoning — Urban Residential 3.5 (UR-3.5)
Existing Land Uses — Parcel No. 45263.2101 is vacant. Parcel
No. 45263.2705 has one (1) Single Family Residences and two (2)
detached accessory structures.
II. FINDINGS OF FACT AND CONCLUSIONS
COMPLIANCE WITH THE STATE ENVIRONMENTAL POLICY ACT(SEPA):
Findings:
Ordinance No. 48 (effective March 31, 2003) adopted on an interim basis by reference the Spokane
Environmental Ordinance (Spokane County) thereby implementing the State Environmental Policy Act
(SEPA) and Chapter 197-11 of the Washington Administrative Code (WAC) within the jurisdictional limits
of the City of Spokane Valley. WAC 197-11-800-6 (Minor Land Use Decisions) specifies minor land use
decisions that are categorically exempt from SEPA review.
Conclusion(s):
The Current Planning Division concludes the request is categorically exempt pursuant to WAC 197-11-
800-6 (Minor Land Use Decisions).
COMPLIANCE WITH SPOKANE VALLEY INTERIM SUBDIVISION ORDINANCE
Findings:
Section 12.100.110.d specifies that the division of land for the purpose of adjusting boundary lines
between platted or unplatted lots or both, which does not create any additional lot, tract, parcel, site or
division nor create any lot, tract, parcel, site or division which contains insufficient area and dimensions
to meet minimum requirements for width and area of a building. The proposal is for approval to adjust
the southern lot line of Parcel No. 45263.2101 by moving this lot line north by one hundred and
seventy-one (171) feet thereby reducing the depth of Parcel No. 45263.2101 by one hundred and
seventy-one (171) feet and reducing the total square footage of this parcel by 19,152 square feet for a
revised total lot area of 16,484 square feet. . The depth of Parcel No. 45263.2705 is proposed to
increase by one hundred and seventy-one feet, and the total lot size will increase by 19,152 square
feet or 0.44 of an acre to a total lot area of 100,223 square feet.
Staff Report and Notice of Decision for BlA-10-04
April 21,2004
2 of 4
Conclusion(s):
The Current Planning Division concludes that the request conforms to the exemption provisions of
Section 12.100.110.d of the Spokane Valley Interim Subdivision Ordinance.
COMPLIANCE WITH SPOKANE VALLEY INTERIM ZONING CODE
Findings:
Parcel Nos. 45263.2101 and 45263.27056 further identified as East 14420 24th Avenue, are located
between Best Street and Adams Street on 24th Avenue. Best Street is designated as a Local Access
Street, Adams Street is designated as an Urban Minor Arterial and 24th Avenue is designated as an
Urban Collector Arterial pursuant to the Spokane County Arterial Plan Map (February 23, 2003) adopted
by the City of Spokane Valley. Section 14.616.310 (Minimum Lot Area) of the Spokane Valley Interim
Zoning Code specifies a minimum lot area of 10,000 square feet for uses in the Urban Residential 3.5
(UR-3.5), and a minimum frontage of 80 feet on a public road or street. The proposed lot line
adjustment will increase the lot size of Parcel No. 45263.2705 lot size from 81,071 square feet or 1.86
acres to 100,223 square feet or 2.3 acres, and decrease lot size of Parcel No. 45263.2101 from 35,636
square feet or 0.82 of an acre to 16,484 square feet or 0.38 of an acre. Adjusted Parcel No. 45263.2101
will have one hundred and twelve (112) feet of frontage on 24th Avenue, while adjusted Parcel No.
45263.2705 has access on 24th Avenue from a thirty (30) foot easement. Following the proposed
adjustment, both lots will exceed the minimum 10,000 square foot lot size requirement of the UR-3.5
zoning designation. Parcel No. 45263.2101 exceeds the minimum eighty (80) feet lot frontage
requirement, while Parcel No. 45263.2705 is only accessed off a thirty (30) foot width of frontage on 24th
Avenue by an easement. The boundary line adjustment is not decreasing nor increasing the lot
frontage for Parcel No. 45263.2705, thus is deemed to be sufficient as is to provide access and frontage
to Parcel No. 45263.2705.
Conclusion(s):
The Current Planning Division concludes that the proposed adjustments to Parcel Nos. 45263.2101 and
45263.2705 comply with the minimum lot area and minimum lot frontage requirements of Chapter
14.616 (Urban Residential -3.5) of the Spokane Valley Interim Zoning Code.
III. DECISION
The Current Planning Division after review and consideration of the submitted application and
applicable approval criteria grant CONDITIONAL APPROVAL to BLA 10-04 subject to compliance
with the following conditions of approval:
1. Record the approved boundary line adjustment with the Spokane County Auditor's Office and
submit a copy of the recorded boundary line adjustment to the Current Planning Division within
thirty (30) calendar days of the date of conditional approval. The items to be recorded are as
follows:
a. Cover Sheet
b. Proposed Lot Consolidation Map
c. New Legal Descriptions
2. Obtain an approved building permit from the City of Spokane Valley Building Division prior to any
building related construction at the subject property.
3. A copy of the recorded boundary line adjustment shall be submitted with all future land use actions
or building permit actions for the affected parcel(s).
Staff Report and Notice of Decision for BLA-10-04
April 21,2004
3 of 4
IV. APPEAL OF DECISION
Pursuant to Section 13.900 (Appeals) of the City's adopted "Application Review Procedures for Project
Permits", a written appeal of the Staff Report and Notice of Decision shall be filed with the City of
Spokane Valley Community Development Department within fourteen (14) calendar days after the date
the notice of the decision is mailed.
Pursuant to Section 13.900.110 (Contents), an appeal shall contain all of the following information:
1. The file number designated by the review authority and the name of the applicant.
2. The name, address and signature of the appellant and a statement regarding the legal standing of
the appellant to appeal. If multiple parties file a single appeal, they shall designate one part as the
representative for all contact with the review authority.
3. The specific aspect (s) of the permit decision and/or SEPA issue being appealed, the reasons why
each aspect is in error as a matter of fact or law, and the evidence relied upon to support allegations
of error.
4. All statutory requirements for appeals of land use decisions of land use decisions, including land use
petitions filed in superior court pursuant to RCW 36.70C shall be complied with.
5. Any required appeal fees. Pursuant to the currently adopted Fee Schedule, the current fee for an
appeal of an administrative decision is $250.00. Please note that that this fee may be changed by
City Council adoption of an ordinance updating the Fee Schedule.
Pursuant to Section 7 of Ordinance No. 57, the Hearings Examiner shall conduct a public hearing on
appeals of administrative decisions made by the Current Planning Division. Pursuant to Section 11 of
Ordinance 03-081, the Hearings Examiner's decision on the appeal shall be final and conclusive and
shall have the effect of a final decision of the City Council.
Standing to appeal a decision shall be determined in accordance with the provisions of Section
13.900.102 (General).
p:\community development\current planning\boundary line adjustments\bla-10-04\bla-10-04staff report.doc
Staff Report and Notice of Decision for BLA-10-04
April 21,2004
4 of 4
EXHIBIT 1
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EXHIBIT 2
.S�r<r CITY OF SPOKANE VALLEY (For Staff Use Only)
rp .he Community Development Department '/
.00 Valley Current Planning Division DATE SUBMITTED: D`('13' RECEIVED BY:
,aso
11707 East Sprague Avenue, Suite 106 FILE NO./NAME: ^li)-
Spokane Valley, WA 99206
Tel: (509) 921-1000
rsr.Ffq4.:.,(5,.• 921-1008
I�Ictt -.okanevallev.orq CURRENT PLANNING FEE: YfUV.GO
ENGINEERING FEE:
2004
BC Nill/i 11Ti}A' LINE ADJUSTMENT/ELIMINATION APPLICATION
COMMUNITY
/�DEVELOP MMENT
fECEM
APR 13 2004 PART I —APPLICATION TYPE
(Check One)
SPOKANE VALLEY
DEPARTMENT OF
• COMMUIRDEvf gP a'Tary •Line Adjustment 0 Boundary Line Elimination
PART II —APPLICATION INFORMATION
LOCATION OF PROPERTY(IES): ec.fi06 oiN p'5 Ili" `o --
TAX PARCEL NOS.: ✓2 706 3, 2/0/
STREET ADDRESSES: /P9#9,20 _2 y Atilt.
ZONING DESIGNATION(S): !ii. R. ,3 3
GENERAL PHYSICAL DESCRIPTION OF PROPERTY(IES)INCLUDING CURRENT USES: 3, 2 705 ONCE flame
.3.?/t7/ SABRE aaY1.tJt/Alb
SIZE(SQUARE FOOT)OF LOTS BEFORE ADJUSTMENT OR ELIMINATION:8/4080. 2�
SIZE(SQUARE FOOT)OF LOTS AFTER ADJUSTMENT OR ELIMINATION,-ea *VZ T I4IO &' .00T 2
*if more than two lots,provide information on a separate sheet of paper
APPLICANT INFORMATION:
APPLICANT: in,"A TRO7ER_
MAILING ADDRESS: FAST /Y3'.20 .•?V -22e '09
CITY: 57e/619./E., 4141-L0Y STATE: L,J4 ZIP: 99037
PHONE: (HOME/WORK) 9ZZ-dgS•?7 (FAX) (CELL) 95me-/56751
Please Circle
NOTE: IF APPLICANT IS NOT THE OWNER,INCLUDE WRITTEN OWNER AUTHORIZATION FROM THE LEGAL OWNER BELOW:
OWNER INFORMATION: .,f,�
PROPERTY OWNER#1: -T/A,1TRO i /�i/e-
MAILING ADDRESS: e. / /' .20
CITY: 510✓ Aie- U/94 (Y STATE: iA. Zip: 770
PHONE: (HOME/WORK)7.2.2 06"7 FAX) (CELL) 79y/s88
Please Circle
Version 1:01/04 1
_ P
JIM TROTTER
PROPERTY OWNER#2: 14420 E. 24TH AVE
MAILING ADDRESS: SPOKANE VALLEY WA 99037 9477
CITY: STATE: ZIP:
PHONE: (HOME/WORK) FAX) (CELL)
Please Circle
PLEASE NOTE: ALL SUBMITTAL REQUIREMENTS SPECIFIED IN THE SUBMITTAL
CHECKLIST FOR BOUNDARY LINE ADJUSTMENTS/ELIMINATIONS SHALL BE
SUBMITTED BEFORE THE APPLICATION WILL BE PROCESSED. _
PART III - LEGAL OWNER SIGNATURE
• (Signature of legal owner or representative as authorized by legal owner)
T./AA 7-7Z0 R-- , (print name) SWEAR OR AFFIRM THAT THE
ABOVE RESPONSES ARE MADE TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE.
I FURTHER SWEAR OR AFFIRM THAT I AM THE OWNER OF RECORD OF THE AREA
PROPOSED FOR THE ABOVE IDENTIFIED LAND USE ACTION, OR, IF NOT THE OWNER,
ATTACHED HEREWITH IS WRITTEN PERMISSION FROM THE OWNER AUTHORIZING MY
ACTIONS ON HIS/HER BEHALF.
ADDRESS: 4-4•57– 19V•240 -7y� ,9 vE PHONE: 92,Z -6557
6Po. 0,9-AL. f' l cM. ZIP: 99437
(City) (State) # /3.°---0
(Signatu (Date)
NOTARY
(For Part III above)
STATE OF WASHINGTON ) ss:
COUNTY OF SPOKANE )
SUBSCRIBED AND SWORN to before me this /3/4/ day of 4pri , 20 D
NOTARY SEAL i
4-PPealL4-6-"--)
NOTARY SIGNATURE
Pt.SSNA44 '1I
Q ‘s slonr 'O � Notary Public in and for the State of Washington
8 Now), Residing at: 5/00/ULit 0 Vaal/ (c)4
cn — • ._ O ;
PUBLIC
IP- My appointment expires: /D 707
PLEASE NOTE: THE SPOKANE COUNTY ASSESSOR'S OFFICE WILL REQUIRE EVIDENCE THAT A BOUNDARY LINE
ADJUSTMENT OR ELIMINATION HAS BEEN RECORDED WITH THE SPOKANE COUNTY AUDITOR'S OFFICE IN
ORDER TO UPDATE PROPERTY INFORMATION. INFORMATION REGARDING THE SPOKANE COUNTY AUDITOR'S
RECORDING REQUIREMENTS IS ATTACHED TO THIS APPLICATION PACKET.
Version 1: 01/04 2
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4;.; 4COMMUNI Y DEVG LO{' MENT, DE A TMENT:;,�' ° ,
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40,Valley ;. ,,�r. `Y�n '1 „•'''',y;.P.A.'� a� `a"'� ,41"p a'".+..' ,{'+fid iPi ., l�$ '..'`3.. ,, AL
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x--t.: BOUNDARY LINE s-;
,il. - „ ADJUSTMENT/ELIMINATION ,
1 • SUBMITTAL CHECKLIST
❑ SUBMITTAL CHECKLIST
APPLICATION FORM
Submit completed application on the attached form with all required information specified and all
signature blocks completed.
. );‹ CURRENT APPLICATION FEE $ I CO.
ASSESSOR'S SECTION MAPS
1:200 scale map of: 1/2; section ; township ; range
Submit one (1) copy of the above Spokane County Assessor map(s), with your property (ies)
highlighted.
XEXISTING CONDITIONS SITE PLAN: Provide a to-scale one (1) 81/2 inch x 11 inch plan
showing the following information:
1. The dimensions and square footage of the existing property/properties involved.
2. The location of any improvements (any structures, septic system, etc.).
3. The location and dimension of any access or utility easements.
4. The location, dimensions and names of public and/or private streets abutting the property
(ies).
5?.. PROPOSED ADJUSTMENT/ELIMINATION SITE PLAN: Provide a to-scale one MI inch x
11 inch plan showing the following information: I " r/�(,(,1-Provide,
O✓ \
1. The proposed dimensions and square footage of the property properties involved.
2. The location of any improvements (any structures, septic system, etc.) after the proposed
boundary line adjustment or elimination
3. The location and dimension of any access or utility easements after the proposed boundary
line adjustment or elimination.
4. The location, dimensions and names of public and/or private streets abutting the property
(ies) after the proposed boundary line adjustment or elimination.
12( Metes and bounds legal descriptions for the existing parcel(s) and proposed adjusted or
eliminated parcel(s) prepared by a professional surveyor licensed in the State of Washington
1j "" vv-\a'+ �5 o \cw 4..�S
One (1) copy each of all involved property owners' recorded deeds, verifying current ownership.
Letter of intent explaining the purpose of the request including any special circumstances that
may be helpful in evaluating the request.
Copy of record of survey for existing lot(s).
ii/c-
Vtik< RECORD SURVEY OF PROPERTY: If you are proposing to decrease the distance between E
property line and any structure on the site, it is required that a record of survey of the property be
done to prove that no illegal building setbacks will result from the boundary line adjustment. ThE
survey must be done by a surveyor licensed by the State of Washington who must affix his or hei
professional seal and signature to the survey. The survey must be recorded at the Spokane Counts
Auditor's Office and a copy of the recorded survey must be submitted with the application fol
boundary line adjustment.
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• CITY OF SPOKANE VALLEY Date: 69..( 3 .0-)
Receipt for Planning Division Fees By: lc._
Applicant/Business Permit# -CY-I.
Project Name - (�ria
Site Address
Please receipt the following:
Check Number 5 3 Sf(,) Cash CC
Payer's Name "1SraeLuCI-14.J _ e071141<--
Address
orii `Address 1+42.0 Q-. CA_I,v , ( . City . Zip W 9mU3-7
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001.058.058.321.70.01 Entertainment License
001.058.058.321.90.02 Home Profession
001.058.058.395.10.01 Street Vacation Permits
001.058.058.345.83.02 Conditional Use Permit
001.058.058.345.83.27 Temporary Sign Permit Fee
001.058.058321.10.90 Temporary
‘"*":166.4
..,Usei,.P—_Germ_S.it Fee
.y �'7: ;4 L I���` �4ii ^S4
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001.058.058.345.83.01
df
Rezones
001.058.058.345.83.03 Prelim. Short Subdivision
001.058.058.345.83.04 Short Subdivision
001.058.058.345.83.05 Preliminary Subdivision
001.058.058.345.83.06 Final Subdivision
001.058.058.345.83.07 Shoreline Dev.Permit
001.058.058.345.83.08 Prelim.Binding Site Plan
001.058.058.345.83.12 Zero Lot Line
001.058.058.345.83.14 Plat Modifications
001.058.058.345.83.15 Change of Conditions
001.058.058.345.83.16 Admin.Decision Appeal
001.058.058.345.83.17 Zoning Map Amendments
001.058.058.345.83.18 Administrative Variance
001.058.058.345.83.19 Variance
001.058.058.345.83.21 SEPA Review
001.058.058345.83.22 Planned Unit Development
001.058.058.345.83.23 Sign Review
001.058.058.345.83.24 Code Text Amendment
001.058.058.345.83.25 Administrative Exception
001.058.058.345.83.26 Site Plan Review
001.058.058.345.89.03 Appeal of H.E.Decision
001.058.058.345.83.27 Boundary Line Adjustment 4. 100 . CJD
001.058.058.345.89.04 Comp.Plan Amendment
001.058.058.345.89.05 Sales of Maps
001.018.000.341.69.01 Photocopies
TOTAL FEES t5b ,a)
EXHIBIT 3
• CLARENCE E. SIMPSON
bimpson Engineers, Inc. 1901-1987
RICHARD L. SIMPSON
CIVIL ENGINEERS AND LAND SURVEYORS CHARLES E. SIMPSON
FOUNDED 1946
Licenced in Washington and Idaho
N. 909 Argonne Road Spokane, WA 99212
(509) 926-1322 Fax: 926-1323
PROPOSED DESCRPTION FOR CERTIFICATE OF EXEMPTION
• DESCRIPTION 1
The North 145 feet of Lot 1 in Block 1 of FERGUSON'S SUBDIVISION, as per plat
thereof recorded in Volume 18 of Plats,page 35.
• DESCRIPTION 2
Tract D, Short Plat 87-487, as per plat recorded in Volume 5 of Short Plats, Pages 99
and 100,records of Spokane County;
TOGETHER WITH Lot 1 in Block 1 of FERGUSON'S SUBDIVISION, as per plat
thereof recorded in Volume 18 of Plats,page 35.
EXCEPT the North 145 feet of said Lot 1.
DESCRIPTION OF RECORD
• DESCRIPTION 1
Lot 1 in Block 1 of FERGUSON'S SUBDIVISION, as per plat thereof recorded in
Volume 18 of Plats,page 35.
• DESCRIPTION 2
Tract D, Short Plat 87-487, as per plat recorded in Volume 5 of Short Plats,Pages 99
and 100,records of Spokane County;
EXHIBIT 4
.
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\,0, This site plan Is being submitted for the purpose of
obtaining a building permit and is a true and correct
,1�(�� C. representation of the proposal. All known property
t
,(411�' I v�� — I lines/dimensions,curb Imes,structures and easements
d I have been identified. Also • r- wetlands,
� J bodies of water, ste,• . • or other critical areas.
'1 A0u �► Signed. ,l_ _ /I� _—
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