BROADWAY E 6010 PONDEROSA DRILLING NEW OFFICE & TRUCK STORAGE
. • BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOUUNDERSTAND
(Please return ihis original anG your buildrng plans to Ihe Department of Building and Safety),
1 0A s PWme ylasty tl~rstf Im) Lr ment UseQnlr
9 ei T~l l, c_..Z com,n
? ROJ6Ct Add/ess (not Meihng Add►esa) O' Hoad Name SPace 2Ip
r- • 6 v 10
~eo~an~0.~f ~9 Zp ~
3 GtylCommuryltlr - Slete SubOfwleiOnlPlgt HBme ~ST
\04A., . v►i i3s' oc a. zs,` oc c1rz vr -rQOcr I 6 snoiewKE
1 AaaaeW Pproel No Lct 81ak
1 _>3 f 110 3 • ,s OEPARTMENT USE ONLY t • ~r
S 6ic Oode i Zons Act N Zonu P►ojed ,No
8' Owell / No ot 8uildings Sq ft lACta OePlh irontage
7 Set Baclc-Frant 0.11S1 (R)S2 Rear Oonaw Tract Module No IMUafa
° 18 ArWtiki fftm Nafne S1ree1 AddFess °
1L t~+~1 ~~o~ ~w.aG1 S. Z6L~ ~ o►rt FI F~.~ ~v
ZJOry Sinte PAone
0 99~i g /Ai~z...i4-~
' cbr►iecs Paaon PAone Ir dlrtweni ehan ahova
~ 'Z46.* -aEwtvGt Aa240 1 5:[S- 46f&
1 L Conttectot Flrm Name ~ Sueet Adotess
j~;;d,e G v ~Ca.~S►f c2.uGT t p.J 3$zD'~~ya,rr~N
2ip Clry 51ete PAOno
'9 9zvt SPa,cA~ ~hlo►. ~ t, 53~i
CQnted Pe►eon Llcense No PAane It dlfferent than above
~
8 Ow+ier,fAQenl pf dillerent lltan 00 aWVe) Buatness Aadlesa
e z,o a~► ' stete Phom
c ~
12 Revlew i:equlr6d Plan C/+eclt (Y!N) ~ Ofh@► (`f/N) SEPA E.xempt (Yi N) ~ Oate
~ 15 Type,Vlfork $l Bidg q MH ~ Naw ~9.Realece O O1her
O Flre p pemo r! AdQlAlter O Move
14 oeacribe w" ~ -r~ 1ZiE' Qt•4 cE E lc~sr• .
~1,Ew bGGI G~ , -r¢u~K, srazo.G,~
, ~
10 Applkant Natfle 8treel Addreaa
11 ZJp Clty State ' Pltorea ~
I 1
~ Lencler i~• ~ 81reBt Add►eso
ap stete Phoe
contad Peraon Plwno Ir atne►eM than aDova
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Addlaonal tntarmatton
. - - ■
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return thls original and your bu(Iding pRWE`kwcopartment of Building and Safety)
s I` i +ft
~ 1 Owner's tyame (Iast) (Iirst) i U ~`~m) Oeparlment lbe Only ~
Fbs. ~ Comm
2 ProJeCt Address (not Mailing AddfesS) p- Road Name 91090 1 Zip
E~ . 6 0t o ~eo~P -,&V A,Y 99 Z~ tpl ,
3 C+tylCommunity Stete Subdivision/Plat Name CQST
s~o►~a~E. ~~1~ . w. ~3~' d~ zso' ac ~~iz vf T¢~cT ~~"sno~cAf-AE
- A~Q •
4 Asaeesor Paroel No. Lot - Block
~ I~j~j3~ ( 3O3 DEPARTMENT USE ONLY w* w
5 S+C Code _ Zone Att. M Zorso-i'
~ Project N0.
~IC~~~~.
6 Dwell M No. o( Buildings ~'Sq. Ft.lACro Oepth Frontage
. ~ 3 25e i
7 Set Back-Front (L)S-1 (R)S2 Rear Cersaw Tract Module No. Initials
t 12 u,)
~ 16 Archltect Flrm Name #
Street Addrew
~L€N ~eoE Nt~►~, . S. ZGZ~ ~t~2fIF~~ 2v. '
vP Gty Stete Phone
,9 9Z19 I~►iQ...ia-~ 1~~«,,N~S `r~~* • c ) z44.1-:;, Co~ t
ooncact Peroa, Phone Ir altfe.ent tnan above
"20..\ V-IE L-L, t v GL ~j A4Zc, o .,o..,s-t .l ) 5 3 S- 4 Ga p~ Contractor Firm Name ' Street AdOrees
G,~e cv Ccra~czucr~o~ r=. 3gzo
ztp ab Stete Pnone
~ 9zo z Sra K- A s►-E, 3y -4-c
Contact Person Ucense No. Phone ti different than ebove
20s1 VE. Lv 1 wl (r-1 i )`~~S ~ 46 0 8
8 Owner/Apent (if different Ihan 01 above) Buainess Address
' 9 ZIP CitY ' • State Phone
'
Dy7
7!
12 Revlew Required Pian ptiecJc Other (1flN) SEPA ExemD (Y/ Dete
q~s .~S ~ N ,i 7 20- S,~/- 15 Type Work ~ Bldy O MH Mew ~S. Replece O Other I
D Flre p pemp ❑ AddlAlter O Move
tt pesulbe Work •
"Ew OGGI GE ~ T2uc~, sTo~c,c~~ -rv 2¢vcAC~ ~x,S-r.
10 ApDlicant NaR►e St►eet Addreas
11 Zip Gty State Phone
( 1
•
Lander Street AdGrese f
ZiP Gtp State Phone
Co^tact P'efson Phone Ii dlNerent tAan aDove
( )
Add It fonal Informat lon
.
• {
, I
DEPARTMENT APPROVALS This is not a Permit
Application Type
(Standard unless (Indicated approvals requlred ineither 'retease' or 'release with condltions'
otherwise indicated) space prior to permit issuance.) C] Fast Track
~ Early Start Release
Release w/cond 1 ~ Hotd 2
Environmental Health p Commercial; •~'pResidential
W. 1101 College , p New Construction; O Bldg alterationladdition
- Room 200 O Additionat structure;
APPLICATION #
[u f
- c
Conditions/Comments: '
Planning/Zoning: O Commercial; O Cert. oi Exemption; O Frontage; ~
tbacks• ' lot w/ • lot iz - ~
N. 721 Jeiferson D Se . D d, D s e~ O use/zone;
O CU, variance, zone change; shorellne; 0 tence;
O Other
Conditfons/Comments: .
~f Englneers: O Commercial; D Residentlal; O Flood Plain; ~
N. 811 Jefferson O drainage O new access/approach; D tence;
D road improvements
Conditions/Comments:
F] Utliities: .
N. 811 Jefferson
Conditions/Comments:
~ Other: .
El Plan Exam
Flre Prev.
Conditlons / Comments:
ri
~
`
~D
9 Project Representative Telephone
~n Agencles Performing Specfal inspection:
Y O
V Y
Cc tv
r= E 2
~
u. c
3.
1 Indkate above or attach conditions relatlvs to Iinal as buiit approval
2 Indkate above or attach reasons for hold
Plan # : 1298
TxR E sH oL D D E TE R M I N A T 1 0 N PRCIPOSED/FINAL DECLARATIOhi OF SIUNIFTCANCEINU[VSIGNIFICANCE
1,. Proponet . Ponderosa Drilling
Contact Person : Phone: 535-0671
2. County's Actian Reyuested. Building Perrnit/Land use permit
Pursuant C.o WAC 197-10-203, the Spokane Gounty Department of Building and
5afety, , a di visi on pf Spokane County, ,has determined that the county, as an
ACTING AGEiVCY, is the LEAU AGENGY for the fvllowing prvject:
~~_w metal building to replace exist%ng office and shop buildings.
(T-hree seDarate structures } .
Thi s praposa 1 has been deternyined to not have a si gi ni fi cant adverse imparct
on the envi ronrnent . An E IS is not requi red under RCW 43.21C.030 (2)(c
This decision is made after review by the county of a completed environmental
checlclist and other information on file with the lead agency,
if you wisn to exer-cise ,your opition tv review and comment as provide in WAC
197-10-203 (3 )/197-10--340, please respond, if appropri ate, at yaur earliest
oppartunity, ,notirry parti cu 1 ar ly the due date for wri tten comments.
Due Date for Wri tten Cami-nents: August 7, 1984
Proposed Uecl arati on af Nonsiyrri fi cance Issued: July 23, 19$4
'
~
Contact: Spakane County Departrnent of Bui 1 cii ng and Safet,y
North 811 JeffersQn Street
Spokane, WA 93250 (509) 456-3615
, Attentian Kenneth E. Jeffrey
,
,
PRL}POSED DECLARATION FTNAL DECLARATION
Nanie: James L. Manson Name: James L. Manson
Siynature: 9~~&4 . Siynature:
Title: Directar Tit1e: airector
Department: Building and Safety aepartment: Build7ng and Safety
Date: July 23, 1984 Date:
MAILING LIST
TO: Washington State Department ~A
of Social and Health Services - Spokane County Ut1lity
Department
Spokane County
Air Po11ution Control Authority Spok,ane County ~lanning
Department
Spokane Caunty Engineex' s Offic.e
Spokane Cou,nty Health Da..strict
Spokane County Chief Civil Deputy
9
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I
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. t • t~i~
. • . •
• . . .
ENVIR4NMENTAL CHFCKLlST . ,G,:-v` ,p . .
:3 3.FILE
. .
SEC/SWN/RNG:
Introduction: The State Environmental Policy Act of 1911, Chapter 43.21C, RCId, requires all state and locnl
governmental agencies to consider environmental values both for their own actlons and when licensing prlvate
proposals. The Act also requires that an Environmental Impact Statement be prepared tor all major actions
significantly (and "adversely", as per WAC 197-10) affecting the quality of the physlcal envlronment: The
purpose of this checklist 1s to help the agencies involved determine whether Or not a proposal 1s such a
major action.
Please answer the following questians as completely as you can with the intornation presently availnble to
you. Please answer questions as "yes" or "maybe" 1f, in your opinlon,.even only slight impacts will result.
The reviewers of the checklist wi11 be aware of and concern themselves wtth the de9r-ee- of impact, asking you
for more information, if necessary. where explanations of your answers are requ~ red, or where you believe
an explanation would be helpful to government decision-makers, include your explanation 1n the space provided,
or use additional paqes, if necessary. You should include references to any reports or studies of which you
are aware and which are relevant to the answers yau provlde. Canplete answers to these questions now will
help all agencies involved with your proposal to undertake the requ.ired environmental review rvithout unnec-
essary delay.
The following questions apply ta your total proposal, not just to the license for whtch you are currently
applyTng or the proposal for which approval is sought. Your answers should include the tmpacts whlch will be
caused by your proposal when it ts completed, even though completion may not occur vntil sometlme tn Lhe
future. ?his will allow all of the agencies which will*be lnvolved to complete their environmental revlew
now,'without dupllcating paperwork 1n the future.
No aQpiication shall be processed until the checklist has been completed and returned to the appropriate
County department. State law revuires exvlanations for every pyes" and "maybe" answer on the checlcllst.
The person completin9 the form may be required to provide explanation for "no" answers, and 1n some cases,
more detailed lnformati.an to aid in a threshold determination.
NOTE: This is a standard form being used by all state and local agencies in the State of Washington for
various types of proposals. Many of the questions may not apply to your proposal. If a question
does not apply, just answPr it "no" and continue on to the next questlon.
ENVIRONMENTRL CHEGKLIS? FORM
1. BACKGROUNO .
1. Name of Proponent: t-L-''`''Gn Qhone Number: 535 - 0 6-71
2. address of Proponent: C• L o1v 6Z0Ar7 v4AY
3. Oate Checkl i st Submi tted: -7(Zor8 `E'
4. Agency Requi ri ng Checkll st: G ou "-r --e vc, SPor- p,►aE 157t.-r,7CV•• eor,-r~ 'c7¢ r",T• ,
5. Name of Proposal,- if Applicable: • ,
6. Hature and Srief Oescription of the Proposal (including but not limlted to its size, general design
elements, and other factors that will 91ve an accurate understandtng ot 1ts scope and nature):
1a~W METpt, gIJ7" C--1. - 7K'7S~ 40~ ~C 1►5~ 0fCI F- 42EA. Tor~o.L.. 1t~tiZ?Xs yQ.fT-
-f o ~Z EQ ~4 C E E k i ST . O~ 1 G~ ~ 5 Nv ~'TC c.1X+~' • `
i
. 1. Location of Proposal (describe the physical settin9 of the Proposal, as well ds the extent of the land
area affected by any envirionmental Smpacts, including any other tnformation needed to give an accurate
understanding of the environmental setting of the proposal):
W. 1 3S' 0 F'1S . LSJ' lOVz IE 1 IL vr- TFAGT 1(o . FG+~sT _-_pol<AN~ r%
8. Estimated Oate for Completion of Proposal:
9. list of all Permits, Llcenses or Government approvals Required for the Proposal (tederal, state, and
1 ocal - i nc1 udi ng rezones e-c>oE V7c-r1T- ,
CJ v NT Y ~1 ~ 4 t~'T ~-1 ~~`EP T. .
10a, Do you, or the owner in the event you do not own the subject land, have any plans for future additions,
expansion, or further activity related to or connected with this proposal? if yes, explain:
~ oT A'Z' TH1 S T11✓1 ~
~
Au9ust. ;`9=~1
Y . • •
1 y .
♦
,
lOb. Do you own or have options on land nearby or ad,jacent to this proposal's location? If yes, explain:.,
11. Do you know of any plans by others including the owner which may affect the property tovered by your
proposal or land adjacent or nearby? IF yes,-explain: Nl.o
12. Attach any other application form that has been completed regarding the proposal; if none has been
completed, but is expected to trefiled at some future date, describe the nature of such application
form: ~Ao~E II. ENVIRONMENTAL IMPAC75 .
(Explanations of all "yes" and "maybe" answers are required)
l. Earth. Will the proposal result in: Yes Maybe No
(a) Unstable earth conditions or in changes in geologic subsKrut•tures?. ~
(b) Disruptions, dlsplacements, compaction or overcovering of the soill. ~
(c) Change in topography or ground surface rellef features? . . . . . . . . . . K
(d) ?he destruction, covering or modification of any unlque geologic or
physical features? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(e) Any increase in wind or water erosion or soils, either on or off the sitel.
(f) Changes in deposition of erosion of beach sands, or changes in siltatton,
deposltion or erosion which may, modify the channel of a river or stream
or the bed of the ocean or any bay, inlet or lake?. . . . . . . . . . . . . ' ~
Explanation; SEg P9rT4G1-Nrc,t7 N.~~rES ,
2,' Air, wili the proposa) result 1n: Yes Maybe No
(a) Air emissions or deterioration of ambient air quality?. . . . . . . . . . ~
(b) The creation of objectionable odors? . . . . . . . . . . . . . . . . . . . • X
(c) Alteration of air movement, moisture or temperature, or any change 1n X
cl imnte , ei ther local ly or regional ly? . . . . . . . . . . . . . . . . . . . .
Explanation: ,
3. Water. Wi11 the proposal result in: Yes Maybe No
(a) Change in currents, or the course or direction of water movements,
' in either marine or fresh waters? . . . . . . . . . . . . . . . . . . . . . .
(b) Changes in absorption Yates, drainage patterns, or the rate and
amount of surface water runoff7 . . . . . . . . . . . . . . . . . . . . . . . ~
(c) Alterations to the course or flow of flood waters?. . . . . . . . . . . . . ~
(d) Chdnge in the amount of surface vater in,any water hody? . . X
(e) 0lscharge inta surface wdter, or in any alteration of surface water
quality, lncluding but not limited to temperature, dissolved oxygen or turbi di ty? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >G
(f) Alteration of the direction or rate of flow of ground waters2 X
(g) Change in the quantity of ground waters, either through dlrect ,
additions or withdrawals, or through interceptior of an
aquifer by cuts or excavations? . . . . . . . . . . . . . . . . . . . . . . . ~
(h) Oeteriaration in ground water quality, either through direct .
injectlon, or through the seepage of leachate, phosphatest
detergents,waterborne virus or bacteria, or other substances
into the ground watersl . . . . . . . . . . . . . . . . . . . . . . . . . . .
(i} Reduction in the amovnt of water othervlse available for , K
publ i c water suppl i es? . . • • . • . . • • - • • • • • • • • • • • • • • •
2 .
.
. ; • , .
f . .
Explanation: pr1 ScrE 17MAt*._ca.c-,te. Ars Ac¢. 708 ~st'ur~w••~02• • vvEr~P~uw
~UQMwAT`Ee c,oraTQ,J~, ~~CO~~' lt~~ A~EA • • • • • ,
4. Flora. will the proposal result in: Yes •MaYbe No
(a) Change in the diversity of species, or number of any species ot'
flora (including trees, shrubs, grass, crops, microflora, and
aquatic plants)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~
(b) Reduction of the numbers of any unique, rare or endangered .
specles of flora? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(c) Introductlon of new species of flora into an area, or 1n a
barrier*to the normal replenlshment of existing speciesl. . . . . . . . . . . ~t
(d) Reduction in acreage of any agricultural crop? . . . . . . . . . . . . . . . . ~ Explanation:
5. Fauna. will the proposal result in: Yes Maybe No
(a) Changes 1n the diverslty of specles, or number-of any species
of fauna (birds, land animals lncluding reptiles, flsh and ,
shellfish, benthic organisms,insects or microfauna)7. . . . . . . . . . . . . X
(b) Reductton of the numbers of any unique, rare, or endangered .
species of fauna? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(c) Introducti on of new speci es ot fauna 1 nto an area, or resul t
in a barrler to the mlgration or movement of fauna? . . . . . . . : . . . ' X
(d) Oeterioration of existing fish or wildllfe habitat? . . . . . . . . . . . . . x
Explanation: . '
6. Noise. . ' Yes Maybe No
(a) Will the proposal lncrease existing nolse levels? . . . . . . . . . . . . . . 7<
Explanation:
7. liqht and Glare. ' Yes Mavbe No
(a) Will the proposal produce new light or 91are? . . . . . . . . . . . . : . . . X
E xp 1 a n a t 1 o n; D K S(T E YenrL t;:-, ~ ~~~~'r► ►-1 ~ / s HP-t ~.n AS P1i C £.L r. cT, G, v vE.
8. Land Use. Yes Malbe No
(a) will the proposal result in•.Lhe aiteration of the present or
planned land use of nn area? . . . . . . . . . . . . . . . . . . . . . . . }C
. .
Explanation: '
t
9. Natural Resources. Will the proposal result in: Yes Maybe No
(a) Increase tn the rate of use o.f any natural resourcesl . . . . . . . . . .
(b) Depletion of any nonrenewable natural resource? . . . . . . . . . : . . J'C '
• ~
Explanation.. 4A(Q
~ ZjrOWA,~V' . , .
: 3.
~
■ ~
- r ~
10. Risk of Uoset. Does the proposal invalve ar1sk of an explosian or the Yes Laybe No
release af ha aardous subst.ances (incl Udi ng . but nvt 1 imi ted to, oilt
pesttcides, chemicaZs, or tadiation) In the event of an accident vr
upseYr 4eoi113iti}i1Ls? . • • ! e ! e ■ • • • . i . ! f • i . • 7 • ■ i • • a i • * . y
Lxy1 anati an :
11. Populatian, Will the prvposai alter the location* digtr#bution. +density, Yes MaXbe Ho
or grawth rate of the hurr►afl poQul ati on of an areV . . , . . . . . . . a a . e . .
K.
5xplanatian:,,
.
q2. Ho s_i ng, Wi l1 the proposa~ affect existing housing. or create a demafld for Yes Mavbe No.
a ditional housjng? . . . . . . . . . . . . . . . . . . . . . . . « , . . 6 . . . ~
Exolanation: ~
13. TransDOrtati onJCi rculati on. Wi lithe prap05al result i n : Yes Mavbe No
(a) Generation of addfitional vehicular movement? . . . . . . . . . . . . . ~ . . '
(b) Ef#'ect.s an exfi sti ng parkl ng facilities* or denand for new park3 ngT . . . . . -2C .
(c) impact upan existlng transportation systens7. . , . , ~ . . . . . . . . .
(d) Alterations to present patterns af circulation or mavement of pe4ple and/or goods? . . . . . . . . . . . . . . . " . . . . . . . . , . ~
~
(e) A]terations t.a waterborne, rail ar air traff1c7. . . . . . . F . . , . ~
Increase in traffic hazards, to motor vehicles,- ~ .
bicycliS ir.l } 4r pedestriaF1s?r r • • • i ■ ■ 4 ■ ■ r r ~ • F f r • • s w ■ • Explanation: . Sf_k~- P,TrA.cAAe_r7
14, , Pc,b t i c Servi ces. Wi ll the proposal ha.ve an ef~ect upan, or resul t -Yes ~aybe Na
in a need ~vr nerr or altered governmntal servtces In any+ of the follawing areas;
- (a) J i` e p1 11~ecti4Jnf r • a s ♦ t w r r r • • r • r r • • • ■ • • a M ~ s b • ~ a•
(b) PQlJce Fry~ec4iVni• • • . • i s r • • • • ■ • • . • ~ • i r ~ • ~ ~ ~
(c) Scf=oylsd a a • ~ ~ • . • s f • ■ • r . # • ! ~ • r i ■ • • ■ • ~ i i r s ■ • ■ ~
(53) Pai ks 1.+r vtJler 1 ec1 Gation511l fairilitiLs? • • . r • a • . # • • • r r a n f f ~ •
(e) Maintenance of pub]ic facilitfes. includTng redds"t. . . F . t . ~ . . . . . . je-
(f) Other govef-nrnental senrices? . . . . . . . . » . . . . . . . . . . . . . . ,
E418natian:
_5Ur26-,. Z_ Loej~,-,-rt oNl ❑ta ~m c) vt-r y .
15. EnerqX. Wi l1 the propos a3 result in: Y~s !Laybe No,
(a) Use of substantial arnounts of fuel or ener4y7. . . . . . . . . . . . . . . . lC
~
(b) Liefnand upon ecfisting sources vf energ,y, ar requfire
the development of new svurces of energy? . . . . . . . . . . . . . . . . . . ~
Explanation:
. ~
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4
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' 16. Utilities. Will.the proposal result in a need for new systems. • Yes Maybe No
~ or alterations to the following utillties: '
(a) Power or natural gas? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
(b) Carmunication systems? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c) Water? ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(d) Sewer or septi c tanks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >C
(e) Storm water dralnage2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x ' ( t) Sol i d waste and di sposal2 . . . . . . . . . . . . . . . . . . . . . . . . . . . Explanatian: ~tf hcT-TALtAEQ L-►sT. Svr,> p,r'--V~iT1'o_A' f-- vic
~G l~ E GT . ~ ~tprc.i►~ ~ 2 P.i •wl Gc1~ AS G O ~7~ ' .
. Yes Maybe No
17. Human Health, will the propasal result in the crEation of any health hazards
or potentlal health hazard (including mental health)?. . . . . . . . . . . . . . . .
Explanation:
Yes Maybe No
18. Aesthetics. Wi.ll the proposal result in the obstructlon ot any stenic vista or
. view open to the publtc, or will the proposal result 1n the creation ot an
eesthetically ofiensive site open.to public view7. . . . . . . . . . . . . . .
Explanation:
e No
Yes M, ayb
19. Recreation: Will the proposal result in an impact upon the qualltjr or
quantity of existing recreatlonal oppertunities? . . . . ~ . . . . . . . . . . . . `yC •Explanation: . . Yes Maybe No
20. Archeoloqical/Historical. Will the proposal result in an alteratton of s._..
significant archeologlcnl or historical s1te, structure, object or building? yC
Explanation:
111. S I GNATURE
I. the undersigned, swear under the penalty of perjury that the above rtsponses are made
truthfuily and to the best of rty knowledge. I also understand that, shoul~d there be any rvtll-
ful misrepresentation or willtul-lack of full disclosure on rty part. Spokane County may with-
draw any declaration of nonslgnlticance that it might issue 1n reliante uPon this checklist. '
Date: -7 (z.,o (94 Proponent: ~rAZGD Go~er,
(Please Print or Type) Proponient: V0►.1VVrt.0sA T~.~~~w-►c-~ Address: sPo, c4*3 E
Phone: 535- 0671
Date: 1 Zo 1o
Person compl eti ng form: 20" Phone: 535 - 4(. $8 ~
GtAeG O Gyo~ S.'f .
FQR STAFF USE ONLY ,
Staff Member(s)•Reviewinq Checklist: Based thls staff review of the environmental checklist and other e nt into t n, h staff:
A. Concludes that there are no potentially si9nificant adverse lmpacts and recammends/lssues
a prooosed declaration of nonsiqnificance.
6. Concludes that potentially signlficant adverse impacts do exist and reconmends/lssues a
final declaration of siqnifi-cance. •
C. Concludes that there are no potentially significnnt adverse impacts and, because-ot the
nature of the proposal, recommends/issues a final declaration at nonsiqntficance.
.
i s ed:: Augus t, 1981 S ,
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lb. Excavatian for- footings and perirneter wal I.
ic. 3b.f. Site grades wil1 be altered ta direct
16e. run-off to on si te catch basins.
7. AlZ building 3ights wi-11- shielded to avoid glare. 9b. 15b. lba. Gas and electricity wiXl he consured as required
for heat and li ght.
13b. On site parkang wi 1l be pravided
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