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PLAN NUMBER APPL ICAT 14N / PERM IT pERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY f
- NORTH 811 JEF'FER80N i SPOKANE, WASMlNOTON 99Z10 I(609)156-36'!5
APPLICANT: COMPLETE NUMBEAED SPACES - PAESS HARD TO MAKE 3 COPIES
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1 sMEtAOORss Ct~~Z i~~~v7' PARCEL NO
~ , _ . ~2g~-oao 7
2
~ LCrT eLocK SUBOIVI810N LEGAL OESCRIPTIO
L~ ~ ~~~~~.5► r~1.~Ct I ' ~
OWN ~ONE PHONE
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MAIUMOADDRF.8 ` a Z I~ A~ud 8ef 9eoke (n fael ta ,
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Nbm )BOlllh Eot ~ VU8e1 % ,10
OF~RRA OR IICENSE D(P(RES PFtONE Sbeof Pwou toneqe~sMlallon V
-'~►~E%11- ~a'rE:E- ~ai~ O
4
n~~ ss=~~ rV427ro1- Ar- cmd 8arm ~a' a`°° o~o,a ,
DESI6NER PMONE . Oorot Neluvt AenaddedY=tuMan To1a18tdg FIaw Area
5 ~ :3eAc)
AOORESS ZIP MuIn FMor Upper FlOpn 6erwlStofape areenhowe F
6 C1ilUlGE OF USE FROM TO Oore► Dedc UnCr Oedc fln. Bewnent UMin BasenieM
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TYPE NE1N 0 ALT 8'AD'N 0 RPL 0 MVE ND'e" N° Flaa1 N° Rln Roortn No Qwdllnpe
WOAK '~'~L D. 0 pLMB 0 MECH D M H 0 POOL 0 OTHER aE~ Re~tlrod lree❑ NoCE Number
Reo~tved YeeO Nan ,
4E~RIBE VIrORK SborellnmlFlood Hurd Plmn RDqufrod td
8 ti°~ ~C44N~I_2~y veeU NolApplk Q Pmeivea FW'
./aLuarioN soa~ Gas ~aic ~8~~ S owne~e►►b ~ FEES COILECTED
9 unLITIEs ~iva~ 0 s~ ❑ Puab o~e
I hereby oertity ihat I have read and exam(ned lhis appllcatlon and have read the'NOTICE• provielona Included on ~
rev9rse stde, and know the same to be true and correct. All provfsfona of laws and ordlnarcae goveming this type ot ~~~ing
wark will be camplled witA whether specified hereln a not The prenting of e permlt doea not pnaume to gIve au- ;noriry to viotate or cancel the provislona of any other stete or tocal !aw regulattnp conatructton or the perfnrmance
ai constructlon SEE REVERSE SIDE FOR AEQUIRED IN8PECTIONB Ptumanp
SiGNATUAE OF APpLICATION
OWNER OR AGENT DA?E ~
SPECIAL APpROVAl8 SPECIAI CONDITIONS: (SEE REVERSE SIDE FOR NO'ftCE) Plan Check •2-~~"
~+E.iM FiNaL a+rE No'fE : SW4p HRS 6PERf~1IaN si ~ESS oF NoN -coMSus'Rg~
~rn r~eann I 2 rlPE VMa`V.R.jAI.. sTof~AK,E UN4OL 'rN~'c. S~E.1~
Ro~F r~ Na~! - ~om8u S-~ ~a
P+ammng {~'_!"c.Tr~
Are 5E~ ~ ~~T~~IYl1.S(SEE
Fc'!'t'RC~ Mddtdarf
IjTAel+CD 4EZ .~es oN FtM NYDRRr1T 44qj~o hane
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Avve"' C^i►pE, ~ v1j-~ 1.'itE I12`TfpY otG Ta F.E.XAM BA3rj>
~ Enpir+eer ~y Ls`mk-., OIAer (BPedir)
Uld~toes ~
TOTAI S S10• env
EEoA
WNEN MACHINEVALIOATED IN THISSPACE, ~ Q
PERMIT IS NONTRANSFERABLE TMIB BECOMES A PEpMIT
> ~n •~i~ '
PERMiT IS NULI ANO V010 IF WORK HAS NOT COMMENCED
4 ~ IN 180 pAY8
CAhiB$UED PERMIT NO
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Ad t ~ s ~ ~~r ~ ~ .~~v~`r~ ~-r~rr,~.~~ ~ , ~ - - -
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1.~~.t1~t v'~~i~t t w 1' t,~ i f'~~ ~i~ ~ . s- t ►
~ "th ! Kt 1 41
rhis toiii 1 1 i~ig, pet ii C ii,'k- t, EO[o-isdtst t~ t r~i villi ,►t [1li iinl,rovi•tnc itt rtiatfwAy, 0de-
a, I tk , -ir t)r rnw its, r I•I & .ll wlo ls to ►uli .r h, ►il st su. ii,i in iti~,~►c~i ~r_ tc,ii wi t!i -lu+,r bui lcling
lircnitt . !lol-, , ItN. ki ~,r wi I I 1,o ttI t• !sit., i t 1,, t-i -i it•# r's -,t il tirY,l .3 rorY wi 1 1 he re-
Curnz1 i I.e> yat th~- t tiut • I I t ir ~ Itr 1, t its it iti ' nft iil, .1 hv the.► h.rtg~~isvertng Ihej-«,trtment. A!1
reiatt1 rPmc►=t t ,-,li I l I h. ~swnll, l., t o-I i,t t.ar t o i-. ti int ~0 l hc bioildtn}; pecmit. Al1 lincltAcked
huxey re quf tc +d4iit ((ito ►1 ttq~~-a r ~ h,i intI►t►nal- i oit 1I) mtke i(it-te-rmiiriiCton.
T. 5tormwatvr LTraii igi- (toti ldrrat in,is
A. -Trer gu f ~Trfiii~•~~~ rW-l" "~.t ►rinw -it i-t M,.iii ix;emetiI 1 yK i ' hoCh (in anrt of f si Ci-.
* ,~o csW' ~=ui~• ~ Ye s ~ No
1. _'t)K ( r►nti t t..t et r'+rt' ~ '
L• Fluntt h<< ii rn•, . ci»st tt-r it1)riti** ~ Yes ~ tvo
3. Storm M i t~iv- ~ Il1 itt ~ Yes ~ No
IL. Planning Acciuii /1
1. Reaane, Cond f r lsin I 1 111c:t- or %I ir innee oii prarecry ~ Yes ~ No
2. Are ceqti3 r2menrs of pl inning .iCCio/1 incUrpocated a Yes ~ No
into si tP r ian
Itt. Righr of Way
1. Does perinit neces,.1[ate R. G. W. dedi cat t~n Li Yer. M No
.
2. Did zone cha»ge reopii r•- R.O.W. de•jt(~atinn Li Yes 4 No
3. Radius at cor(ter n Yes tA Nu
IV. Couaty Road Improvements
1. Roada need to he improved. How wide Li Yes No
2. Curb El Yes ~ No
3. CRP/RIn agreement (Copy of dePCt, c•onCract, or ti Yea No
t i t Ie re oct re ;ii red. ~
P 4 )
4. Plans for imprnvementti pcovidpd Li Ye4 No
S. Sidewal.k ti Yes No
V. Narking Plan b ApprAaLh Location
1. Iteview an<i sigri o# t by 1'raf f I c Li Yes ~ Nn
Approith Yecml r froio F ii?;ineer's Off tce ~ yeR ~ No
J. St.3t •)r ct ry si ;n otf ~ Yeoi ~ ku
Is rliis rnaci f►si t► YR-ai Plan ~ Yeq No
V 1. ULY U Agreemen C. j~ Yes No
Y[I. Field !'eview. vrel iintt,.icy ('o,jmrnrR
k ~--t ">t'tmtil Afi, tdhvt -tv. iit. S1 i s °i., i IiIc, Ir. t I~a ( li1t1, v h. v I -
+ ~.•!l I~,i < rr,.. ic, t-r,rmwAr- r tro•itmkill to> > ititiyt ,iC••, tr yl f it p.riliiudwat1 1
it ~ i, r w mw ~t:,r M to, .K in# 14s6,4roi ,o t ~,~~~t v
~1 ♦ ~ 11 •kq I,, Ill / 111'sII• I
I i 1 ♦i r i 1i I S I I1l ) ~ ~ ~ I ok. 4l~ ~ ~ 1 t~ d 3~ ~
ti i ~ •l ~ d i 1d t 1 tl" ^ 11trellll I ~1 v fT Ip a 1 1 l 1111I e 1; j• 1 C
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Contact Person Name .SAMNES__ MclbrlWi1!~~ 6usin~s•, v~m~-------___o ~
Address Mo( Aclclress
Phone . ~ - - ~ Phone ~ _ _ _ - -
County Contact Pprj•an_ I'hotie No. ~456-36011
rc)MMEttC, [AL F3111 Lt)T NG, Nh:ftM 1'C ltKV (EW
This bui lding pe rmi t rev iew is Lntended tu awaise you nf Che i mprovement s ( roadway, side-
walk, rurb, b[armwa[er, ptr. ) whteh muHt be c.0118tructed in assuciation with your builcling
pecmit. Thig checklist wlll be fillPd out hy tlir Engfneer's staff and a copy witl be re-
turned ta yo« at the ttme that the liermi[ ig lnttiated by Che Engtneering Department. All
requirementR shall be rornpleted pctor tu iasuance Uf the building pecmit. All imchecked
boaes require additional regeArch or informAtton to make a determination.
1. Stormweter Drainage Considerations
Per gufSeMneq tor "Stormwatpr Management 1981" both on and off site.
~Q''~
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1. 2(?~t Cons i~~erations* 9. Yes ~ No
2. Flood ha7,;rd zone considerations** ~ Yes ~ No
3. Stotm Urai nagp P 1an ~ Yes ~ No
II. Plaaniag Action !1
1. Rezone, Conditionnl Uge or Vaciance on property ~ Yes ~ No
2. Are cequiremen[s of planning action incorporated ~ Yes ~ No
into site plan
ili. Right of Way
1. Does permit necessitate R.O.W. dedicatioo a Yes ~ No
2. Did zone change require R.O.W. dedic$tion ~ Yes ~ No
3. Radius at corner ~ Yes tA No
IV. County Road Improvements
1. Roada need to be improved. How wi.de a Yes No
2. Curb a Yes ~ No
3. CRP/8ID agreement (Copy of deed, contract, or ~ Yes No
title report required.)
4. Plane for improvements provided ~ Yes No
5. Sidewalk a Yes No
V. parking Plan & Approach Location
1. Review and sign of f by 1Yaf f i c a Yes ~ No
2. Approach Permit from Engineer's Off ice ~ Yes ~ No
3. S[ate or City sign off a YeR No
4. Ia this road on 6 Yeac Plan ~ Yes ~ No
VI. ZTLID Agreement: ~ Yes ~ AIo
YII. Field Review: Preliminary Comments
* All land within the Aquifer Sensttive Area, where deemed Feasible by the County Engi-
neer, ehall incorporate storwwatec treatment to mLtigate the potentiat foc groundwater
degradation. (See Guidelines for Stormwater Martagement 1981, Spokane Board of Cotinty
Commisaioner's Reso2titinn No. 80-1592, as amended. )
The purpose of flood hazard zone review is to mintmize losses due to flooding in spe-
cific areas designated by Flood Hazard Boundary mapq on file at the County Engineer's
OfFice. (See Spokane Aoard oF Countq CommiRStoner's Resotution No. 81-0726, as
amended.)
4/11/84
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