2004, 04-21 Permit App: BLD-04-04153 Garage%�
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,;o*Valley
PERMIT APPLICATION WORK SHEET
SPOKANEVALLEYCOMMUNITYDEVEL 0PMENT k� i
BUILDINGDIVISION
11707 East Sprague A ve Ste 906
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 2 I 3 �T Sp,
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: Q 41 U
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UIGDING PERMff [ CHANGE IN USE [ GRADING [3 MANUFACTURED HOME
[}RELOCATION ®-SIGN 1 TENANT [ OTHER
OWNER / APPLICANT INFORMATION
® OWNER: �Ql l C t/'6� S2 ✓1
PHONE: � 1' �- -7 'b FAX:
ADDRESS:`
CITY,STATE, ZIP
CONTRACTOR: I ] 5
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
COST OF PROJECT:
® APPLICANT:
PHONE:_
ADDRESS:_
F
CITY, STATE, ZIP
® ARCHITECT.:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
BUILDING HEIGHT TO PEAK: 11y
BUILDING DIMENSIONS: C'L-T X
NUMBER OF STORIES: I
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY: (\J G
OCCUPANCY GROUP: U I
CONSTRUCTION TYPE: v
r
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT. PROPERTY SIZE:
CURRENT PROPERTY USE:
R�e�
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:-
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE: G
COVERED DECK:
DECK:
MANUFACTURED HOME SIGN J
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: # OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
INSPECTOR:
ADDRESS:
SPECIAL INSPECTIONS
PHONE:
PHONE:
FAX:
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
® BOLTING ❑ CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
_ mBUILDING STAFF USE ONLY
❑ ❑
❑ ❑
IS PUBLIC SEWER AVAILABLE: YES NO
IF YES: COUNTY CITY
❑ ❑
IS PUBLIC WATER AVAILABLE: YES NO
IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ❑ YES ❑ NO
M
❑
IS THE PROPERTY LOCATED WITHIN ASA: YES
NO PSSA: ❑ YES ❑ NO
DATE:
STAFF:
METHOD OF PA YMENT -
❑ ❑ ❑
CASH CHECK
❑ V%
SA
BANKCARD 0,
EXPIRES: VIN #
AUTHORIZED SIGNATURE.•
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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PLANNING DEPT. APPROVED
BY'
A / L DATE:
$s'
3► s� ��e
RECEIVED
DEPARTMENT OF COMMUNITY DEVELOPMENT
CURRENT PLANNING
ADMINISTRATIVE EXCEPTION
APPLICATION AND DETERMINATION
PART I
APPLICANT: CAS• I"I r cQ E -u A^ SeL �
MAILING ADDRESS: 1 E. 3 1 5T
CITY:V f�A n e STATE: p /ZIP: �� X06
PHONE: (HOME
NOTE: IF APPLICANT IS NOT THE OWNER, INCLUDE WRITTENOWNERAUTHORIZATION FROM THE LEGAL OWNER BELOW
LEGAL OWNER: ` c� i, Ol.s L C.G#^k
MAILING ADDRESS'
CITY: STATE: ZIP:
PHONE: (HOME) (WORK (CELL)
TAX PARCEL NO: y S Z� 3 - �� ZZ STREET ADDRESS OF SITE: S A ✓'\ zC-
LEGAL DESCRIPTION:
_- SECTION(S) D TOWNSHIP LS-- RANGE �f
ZONING CLASSIFICATION: Lkg-- 3.S7- COMPREHENSIVE PLAN CATEGORY: (� l 11
TYPE O ADM1INISTRATIVE EXCEPTION REQUESTED: OAC (3-4s r !, �. rQ[ SET caG
EXPLAIN REASON FOR REQUEST: ��' S h no) J v-3
Q v -'a .T r -t --q v e -S4
k13Q-se
c rol- g C
APPLICABLE SECTIONS) OF ZONING CODE: SL�t7C�"� tZ . to I ( . 3 ZS . -6. Z
NOTE: A SITE PLAN AND SUPPORTIVE DOCUMENTS SHALL BE INCLUDED WITH THIS APPLICATION
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PART II
LEGAL OWNER SIGNATURE
(Signature of legal owner or representative as authorized by legal owner)
I, �°''► �'�
Eva V% S (print name) SWEAR OR AFFIRM THAT THE
ABOVE RE ONSES 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.
T
ADDRESS: l lo -z I C. 3 ) —
(State)
(Signature)
NOTARY
(For Part H above)
PHONE: q� L- 7-73 '�c
ZIP: 4M Z o 6
./- Z2- -/
(Date)
STATE OF WASHINGTON) ss:
COUNTY OF SPOKANE )
SUBSCRIBED AND SWORN to before me this C�,2 nday of F , 20 0
NOTARY SEAL
�SSNALC A
QQ` `Sg10N
�� NOTARY �w
� .. i Z
N n PUBLVC z
NOTARY SIGNATURE
Notary Public in and for the State of Washington Q
Residing at:
My appointment expires: (c) 01`1 ®'7
PART III
(To be completed by the Planning Staff)
* A
DATE SUBMITTED: RECEIVED BY: 1
FEE: %► i FILE No.: kc — ( l - 0
r
PART IV
DETERMINATION
File No: AE -J,1 - 0
The Department of Community Development finds that the information provided by the applicant and required
compliance with the City of Spokane Valley Zoning Code and all other development regulations, does / does not
adverse affect on the adjacent properties nor the public's general health, safety and welfare.
The Department 'of Community Developmeapprove / denies this "Administrative Exemption" as conditioned
below, for the property described in Part I, pur Sections 14.506.000 and 14.506.020 of the Zoning Code.
This administrative exception is subject to the following conditions of approval:
1) This administrative decision shall apply to the subject property indefinitely and may be transferred to future
property owners, heirs or any successor in interest to the property subject to the conditions of approval
contained herein.
2) The applicant and property owner shall comply with all requirements and regulations of the Zoning Code.
3) The applicant shall comply with all applicable development regulations and standards.
4) The applicant and property owner shall comply with the following additional conditions:
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This administrative exception is hereby.approved this ��.n tiay of 1 200V
Approved by:dt�Title: h
Under Section 14.412.041 of the City Zoning Code, any person aggrieved by this administrative determination has
the right to appeal this administrative decision to the City of Spokane Valley Hearing Examiner. An appeal must
be filed by submitting the appropriate appeal application together with the required fee to the Department of
Community Development Current Planning, within fourteen (14) calendar days after the decision is issued. Upon
receipt of a complete appeal application, a public hearing will be scheduled.
For information or questions, please call (509) 921-1000
Rev 6/03
31 STA
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31 ST {L\V 2
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