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2012, 07-18 Permit App, Checklist EGR-2012-0023 Private LaneSTART DATE: Updated March 201 11SV-FS21Public Foi 29-11.doc i Spokane Valley. Community Development Department irmit Center 703 East Sprague Avenue, Suite B-3 pokane Valley, WA 99206 Tel: (509) 720-5240 Fax: (509) 688-003,7. ' ' Derm itcentor(@sDoka n eva Ilev.o rq (Staff Use Only) PERMIT No.: CHECKLIST?: ❑Y ON NIT: LAND DISTURBANCE PERMIT APPLICATION TAFF USE ENGINEERED GRADING ❑ REGULAR GRADING ❑ GRUBBING & CLEARING APPLICANT USE : SITE ADDRESS: ASSESSORS PARCEL NO.: APPLICANT NAME: PHONE: 97?-l&�S Ra S Zi2J 5 c i EMAIL: CONTACT NAME (❑ SAME AS APPLICANT) : ./9 YG PHONE: EMAIL: PROPERTY OWNER NAME: MAILING ADDRESS: Crr : PHONE: .pQ G{AA€ OoGUPAI STATE: L� oje �3 Y'eS5 G� pr,� �(� RECEIVED JU! t R 7nJ9 CELL SII P E,1M;T CEN r EH • SUB # 7-77 RE\ ,--- i CELL: e.y. -e� EMAIL: CELL: 0 CHECK IF APPLICANT ZIP: CONTRACTOR NAME: (®.TBD): ❑ CHECK IF APPLICANT MAILING ADDRESS: CITY: STATE: ZIP: PHONE: STATE LIC. NO.: EMAIL: CELL: EXPIRES: UBI: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: kocitd ESTIMATED QUANTITIES (CUBIC YD): CUT: t j5 FILL: IF CUT, PROVIDE DESTINATION OF SOIL: OVN, j j 4 c7/2-0/,7_, ers\Community Develop ESTIMATED COMPLETION DATE: ---(1 140�z /0/2012_ /20 102 Administration\03 Forms - Official Versions\Permit CenterlLand Disturbance Permit & Checklist 3- Sikikanel� LAND DISTURBANCL ,LD) PERMIT CHECKLIST For Grading, Clearing and Grubbing work outside the Right -of -Way (ROM (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: 7o/ Ai, rec_S Today's Date: 7/l (I �. Project Descripti 5LLCV piat- Signature: Print Name: ',Lk . ,� ScRA/ (-?Ar 5 The purpose of t s checklist is to g er 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 following questions. The first "Yes" identifies the type of land disturbance (LD) permit required. PART 1 — Is LD work exempted or already covered? (SVMC 24.50.020) If so then LD permit not needed. ❑ Yes [j No 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 exploratory excavations done under the direction of a licensed engineer or engineering geologists? If yes, then project exempted from a LD permit. PART 2 — Engineered Grading Permit needed? (SVMC 24.50.030; 2 sets plans, calcs etc. from Engineer) ® Yes ❑ No Will this grading be for a short plat, subdivision or binding site plan? ❑ Yes IN No Will any grading occur in a FEMA floodplain, wetland, wetland buffer, Fish and Wildlife habitat conservation area or geologically hazardous area? ❑ Yes y No 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 El No Will the grading be for a driveway that is longer than 75 feet? ❑ Yes ® 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 ❑ No 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 ® No Will any excavations or fills have slopes at 2:1 (H:V) or steeper and heights greater than 2 1/2 feet? ❑ Yes E-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? ❑ Yes ❑ No Will any excavations have slopes at 2:1 (H:V) or steeper or heights greater than 3 feet? 0 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 EC No 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.