2013, 05-23 Permit RGR-2013-0004 Clear, Grubi
Spokane
Valley
LAND DISTURBANCE PERMIT APPLICATION
(Staff Use Only)
PERMIT No.:
CHECKLIST?: TI ❑ N INIT:
STAFF USE :
❑ ENGINEERED GRADING
APPLICANT USE :
SITE ADDRESS: 3,42.x • c)rkDc."-v`
0mmunity Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
perm itcenter@spokanevallev. orq
REGULAR GRADING GRUBBING & CLEARING
ASSESSORS PARCEL NO.: Li T.15 Li
PHONE: I-()(""1 - 924-22413 EMAIL:
CONTACT NAME gSAME AS APPLICANT):
PHONE:
EMAIL:
Project #-
Li- 0 74
MAY 2 3 2013
CELL:
PROPERTY OWNER NAME: C. p'._.a,4.
'r °�G �,�(�Prl�ti�-CHECK IF APPLICANT
MAILING ADDRESS: 3 4 / Q ( 504 IR. („€- r)
CITY: le peot< "UTA-4 v€ ri'% Q STATE: %^( ZIP: 4 V t'j
PHONE: E L: - 8 ",•- CELL:
CONTRACTOR NAME: (❑ TBD):
MAILING ADDRESS:
'CHECK IF APPLICANT
CITY:
STATE: ZIP:
PHONE:
EMAIL: CELL:
STATE LIC. NO.:
EXPIRES: UBI :
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
is 2.u$s ( Cz- - C l_ -` -1A.1(s pet -T s I7 E
PT2a rC '. ?, .C3AD (-A-# `i f 4-. <'"` sTom-'
V S l 6 A-)
ESTIMATED QUANTITIES (CUBIC YD): CUT:
IF CUT, PROVIDE DESTINATION OF SOIL:
S t-tl'k 5G5dab c.`-7
/-s C.. • ! c,.-(s �-
FILL:
START DATE: s/�3/0d (" ESTIMATED COMPLETION DATE:
/ 22 /20 t �
Signature:
Updated March 2011
P:1Community Development111 Forms1B. Development Engineering\LDPA.doc
Date
Spokan �
Va11ey
•
LAND DISTURBANCE (LD) PERMIT CHECKLIST
For Grading, Clearing and Grubbing work outside the Right -of -Way (ROW)
(For work within ROW need a ROW permit)
Permit Center ♦ 11703 E Sprague Ave Suite B-3 ♦ Spokane Valley WA 99206
509.688.0197 ♦ Fax: 509.688.0037 ♦ permitcenter®spokanevalley.org
Project Address: (3 L1b2 ( 1z0 Today's Date: Vot2-3/2_c t
Project Description: Ct--rr.1 .12-. t Cr t k" ; .s Ea P ::r'- (0Z r3120rf
Signature: Print Name: L7-A H. I (✓ l.._
The purpose of this checklist is to gather information about the proposed.project.so to,determine what land
disturbance permit, if any, is required by the Spokane Valley Municipal Code.
Starting with Part 1 and working from top to bottom, please answer the fbllovt nag-i
The first "Yes" identifies the type of land disturbance (LD) permit required. F? E C F ! \ (E D
PART 1 - Is LD work exempted or already covered? (SVMC 24.50.020) If so then LD permit not needed.
❑ Yes SNo Does your project only have to do with emergency utility work; cemetery graves; eliminating
septic tanks; digging out a basement; building a wall less than 4 feet high; disposal of refuse
that is covered under other regulations; already permitted mining, quarrying; stockpiling, of
aggregate material (rock, sand, gravel, aggregate, or clay) or ex for on/ excavations done
under the direction of a licensed engineer or engineering'geotti stsIf yes` than project
exempted from a LD permit.
PART 2 - Engineered Grading Permit needed? (SVMC 24.50.030; 2 sets plans, calcs etc. from Engineer)
Will this grading be for a short plat, subdivision or binding site plan?
Will any grading occur in a FEMA floodplain, wetland, wetland buffer, Fish and Wildlife
habitat conservation area or geologically hazardous area?
Will the volume of excavation or fill for the project be over 500 cubic yards? (If checked Yes
then a SEPA environmental checklist will need to be submitted for review)
❑ Yes No Will the grading create a base or support for a permanent structure?
❑ Yes No Will the grading be for a driveway that is longer than 150 feet?
❑ Yes N No Will any grading occur in a drainage channel or be for a water feature (like a perennial or
intermittent pond) with a surface area greater than 500 square feet?
❑ Yes Ifs o Will this grading result in the addition or replacement (excluding pavement maintenance) of
5,000 square feet or more of impervious surfaces or the disturbance of 1 acre or more land
or the construction of new drywells or other underground injection control (UIC) facilities?
❑ Yes ErNo Will any excavations or fills have slopes at 2:1 (H:V) or steeper and heights greater than 2 1/2
feet?
❑ Yes gi`No Will any excavations or fills have slopes at 10:1 (H:V) or steeper and heights greater than 4
feet?
PART 3 - Regular Grading Permit needed? (SVMC 24.50.040; 1 set of plans showing grading and
temporary erosion and sediment control; does not require engineering)
[Yes ❑ No Will the volume of excavation or fill be over 50 cubic yards on any one lot?
(ErYes ❑ No Will any excavations have slopes at 2:1 (H:V) or steeper or heights greater than 3 feet?
Yes ❑ No Will any fills have slopes at 2:1 (H:V) or steeper or heights greater than 2 feet?
PART 4 - Grubbing and Clearing (G&C) Permit needed? (SVMC 24.50.050; 1 set of plans showing G&C
and temporary erosion and sediment control; does not require engineering)
,Yes ❑ No Will the G&C work disturb 5,000 or more square feet of area or remove 7 or more trees?
(Note that forest practices overseen by DNR or commercial agriculture are exempt)
❑ Yes gNo Will there be any clearing on slopes or near/in FEMA floodplains, wetlands, wetland buffers,
Fish and Wildlife habitat conservation areas, geologically hazardous areas or erodible soils?
If the answers to all of the questions above are "No" then a permit is not required for the proposed work.
❑ Yes gr No
❑ Yes 0-No
❑ Yes p-No
i