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2008, 05-21 Permit 08001898 Floodplain App--®_,1111111L •. E f ving. Built for.li'ferm ( ti2a..v-7313 fual\\ _ _L ''ll er/yy�W_. On^T!G 'tl BONDED CE e /��ear NORTHWEST MIZEMECIIII HOUSING ASSOCIATION 'For Staff Use Only) DATE SUBMITTED: RECEIVED BY: FILE NO./NAME: CURRENT PLANNING FEE: ENGINEERING FEE: FLOODPLAIN DEVELOPMENT APPLICATION PART I - APPLICATION INFORMATION APPLICANT INFORMATION: APPLICANT: J. 4, Sc) C r f"cc//"" 1 S c s MAILING ADDRESS: / 3 CO 5 /'3 Pi #S UV/G� '' II� p CITY: 5�d Y'1 _ STATE: W Cr Zip: t !2 U 6 PHONE: (HOME/woRK) 468-5 95 (FAx) i g< 2 7 4 (CELL) 93 -" / ? O s Please Circle NOTE: IF APPLICANT IS NOT THE OWNER, INCLUDE WRITTEN OWNER AUTHORIZATION FROM THE LEGAL OWNER BELOW: OWNER INFORMATION: , �/ LEGAL OWNER: I V I OW ( I oil I^ MAILING ADDRESS: 2 �v /a S 6 i s/1 4,4,r 41((c4 CITY: (A4-y Osr 0c4 1 (t STATE: � ZIP: PHONE: (HOME/WORK) 9 G G9 -(4 FAx) (CELL) Please Circle PART II - SUBMITTAL REQUIREMENTS All Floodplain Permit Applications shall contain the following required information. If required and not submitted, the application will be returned to the applicant as incomplete: ❑ Three (3) to -scale (minimum scale is 1 inch = 20 feet) site plans showing the nature, location, dimensions and elevation of the property and identifying the portion of the property located within the designated floodplain, existing or proposed structures, location of proposed fill, location of storage of materials, and the location of drainage facilities. ❑ Proposed elevation in relation to mean sea level of the lowest floor including basement of all structures Proposed elevation in relation to mean sea level for any structure that has been flood -proofed. ❑ For non-residential construction only, certification by a registered professional engineer or architect that flood -proofing methods for any non-residential structures meet the flood -proofing criteria of Section 5.06.08.2 of the City's Floodplain Ordinance. ❑ Written description if applicable describing the extent to which a watercourse will be altered or relocated as a result of the proposed development. No Rise Certification. Version 2 04-05 1 PARCEL NUMBER(S) OF SITE: PART III - PROJECT INFORMATION �15zg4 ?o8S STREET ADDRESS OF SITE (if any): P (CC 5 D c S woo r c c SIZE OF SUBJECT PROPERTY (square feet): Co A 0 0 dt EXISTING ZONE CLASSIFICATION(S): LIST PREVIOUS LAND USE ACTIONS INVOLVING THIS PROPERTY: S P S S - 'gat Areas of Special Concern: Pursuant to Section 5.06.13 of the Spokane Valley Floodplain Ordinance, the following areas shall not be covered by impervious surfaces or fill unless an engineering study prepared by a professional engineering licensed in the State of Washington is completed that shows no impact to the ability of the floodplain to infiltrate, store and release floodwaters. Please check the box if your property is located in one of these areas: ❑ Chester Creek (downstream of Mohawk Road) ❑ Saltese Creek (all areas of ponding and infiltration) ❑ Forker (south of the intersection of Forker Road and Progress Road) ❑ Central Park (west of Park Road) ❑ Glenrose (west of Carnahan Road and south of 8th Avenue) DESCRIPTION OF WORK: 1. Proposed Development Descriptions (check boxes that apply): ❑ New Construction ❑ Alteration & Repair ❑ Stream Alteration [ 'Manufactured/Modular Housing ❑ Road, Culvert, Utilities ❑ Other - Describe: 2. Types of Construction (check boxes t' that apply): 'r ❑ New or Existing Residential: Re p(c c_►- - f 5 tnc ItoAN� square feet ❑,Addition: square feet I� / Accessory Structure: --'1-4-ccc . f a ( ye/cr square feet ❑ Renovation: ❑ Interior ❑ Exterior ❑ Temporary ❑ New Non -Residential ❑ Repair ❑ Utility Installation ❑ Other - Describe: For Alterations, Additions or Improvements to an Existing Structure: If the cost of the proposed construction equals or exceeds 50 percent of the market value substantial improvement requirements shall apply. Please answer the following questions: a. What is the estimated market value of the existing structure?: $ b. What is the estimated cost of the proposed construction?:$ Version 2 04-05 2 3. Filling & Grading ( :ck boxes that apply): ❑ Filling ❑ Grading ❑ Cubic Yards to be Removed: cubic yards ❑ Cubic Yards to be Placed: cubic yards ASSOCIATED APPLICATIONS: This permit is being applied for in conjunction with one or more of the following (check boxes): [c�Residential/Commercial Building Permit ❑ Grading Permit ❑ Land Division Application ❑ Critical Areas Permit ❑ Shoreline Substantial Development Permit ❑ Other - Describe: PART IV - LEGAL OWNER SIGNATURE I, A RESPOES ARE MADE TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE. (Signature of legal owner or representative as authorized by legal owner) I A./I/err; 54.1. , (print name) SWEAR OR AFFIRM THAT THE 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. It is hereby agreed that the City of Spokane Valley, its boards, officers, employees and agents shall be saved, indemnified and held harmless from all liabilities imposed by law by reason of injury to or death of any person(s) or damage to any property, including without limitation, liability for trespass, nuisuance or inverse condemnation, which may arise out of the work covered by this permit, and does agree to defend the City, its officers, employees and agents against any claim or action asserting such liability. Accepting this permit or starting any work hereunder shall constitute acceptance and agreement to all conditions and requirements of this permit and the ordinance and specifications authorizing issuance of such permit. a (Signature) NOTARY (For Part IV above) / Meti o,B (Date) STATE OF WASHINGTON ) ss: COUNTY OF SPOKANE ) SUBSCRIBED AND SWORN to before me this /9 2( day of Ay NOTARY SEAL e Q,B4.c2 _') NOTARY SIGNATURE Notary Public in and for the State of Washington Residing at: My appointment expires: IZ ( 3 I 12011 Version 2 04-05 3 , 20a8 ART V — CONDITIONS OF APPRL AL FOR INTERNAL USE ONLY - TO BE COMPLETED BY THE CITY OF SPOKANE VALLEY Community Number. 530-342 Panel Number. Flood Zone: Flood Zone Depth No.: Base Flood Elevation at Site: Required Top of the Bottom Floor Elevation: Required Top of the Next Higher Floor Elevation: If the structure is to be floodproofed, the required floodproofing elevation or method is: Elevation to which all attendant utilities including heating, ductwork, plumbing ventilation, electrical equipment and other service facilities will be installed or waterproofed: Elevation Certificate Required: ❑ Yes ❑ No Conditions of Approval: In addition to those listed above and below, please refer to attached conditions of approval if applicable. 1. Required Elevation of the "top of the next higher floor" shall be (AE) feet M.S.L. 2. Required Elevation of the "top of the next higher floor" shall be (AO) feet M.S.L 3. Required elevation of flood resistant materials, utilities, etc. or floodproofing construction for non- resdiential structures (the flood protected elevation) shall be feet M.S.L. 4. A "Building Under Construction" elevation certificate ❑ shall ❑ shall not be completed and submitted to the City for review and approval prior to any vertical construction. A "Finished Construction" elevation certificate ❑ shall ❑ shall not be completed and submitted to the City for review and approval prior to human occupancy or final inspection of on -site building(s), whichever comes first. NO HUMAN OCCUPANCY OR FINAL INSPECTION SHALL BE GRANTED PRIOR TO THE SUBMITTAL AND APPROVAL OF THE "FINISHED CONSTRUCTION" CERTIFICATION. Version 2 04-05 4 PAF VI — DEPARTMENT SIGN -OFF &,.,>PPROVAL The following City Departments have reviewed and approved the floodplain permit application and have determined that conformance to applicable conditions of approval have occurred as required through the issuance of the permit: City of Spokane Valley Community Development Department: As the Floodplain Administrator or designee for the City of Spokane Valley, I certify the following has been reviewed and approved by me: ❑ The "No Rise" Certificate submitted to support the proposed floodplain development is approved. The "Building Under Construction" elevation certificate has been reviewed and approved: ❑ Structure elevated BFE + 1 foot ❑ Structure built with waterproofed materials to the flood protected elevation or more Floodplain Administrator or Designee Date The "Finished Construction" elevation certificate dated: 20 . It has been reviewed and: ❑ Returned for more information on 20 - ❑ Approved on , 20_; Floodplain Administrator or Designee Date ❑ For unnumbered A Zones the Spokane Valley Building Inspector will verify that the first floor and all related mechanical and electrical equipment is two feet above adjoining flood area. Floodplain Administrator or Designee Date PLEASE NOTE: THIS PERMIT SHALL EXPIRE WITH THE ISSUED BUILDING PERMIT OR IF THERE IS NO BUILDING PERMIT WITHIN TWELVE MONTHS OF THE DATE OF ISSUANCE IF ACTIONS AUTHORIZED UNDER THE PERMIT ARE NOT SUBSTANTIALLY IN -PROGRESS. EXTENSIONS OF APPROVAL MAY BE SOUGHT IF SUBSTANTIAL PROGESS HAS TAKEN PLACE. Version 2 04-05 45204.0.190 10012 0 2610 City ofSpakinoVallay 45284.9306 4521490N tiit2 F) 0 45291-9867 2010 452319363 eiya SPown. 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