Fillable SITE IMPROVEMENT PERMIT APPLICATION (City of Liberty Lake)

Fill Online, Printable, Fillable, Blank SITE IMPROVEMENT PERMIT APPLICATION (City of Liberty Lake) Form

Use Fill to complete blank online CITY OF LIBERTY LAKE (WA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

SITE IMPROVEMENT PERMIT APPLICATION (City of Liberty Lake)

On average this form takes 18 minutes to complete

The SITE IMPROVEMENT PERMIT APPLICATION (City of Liberty Lake) form is 2 pages long and contains:

  • 3 signatures
  • 37 check-boxes
  • 43 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Liberty Lake

BROWSE CITY OF LIBERTY LAKE (WA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
03/26/2019 Page 1 of 2
Along with this application please provide the following:
o One electronic copy of drawings / plans with supporting documents
o Any applicabl
e plumbing, mechanical, fire, and right of way permit applications
All businesses which perform work in the City must have a current Business License. If the business is located
outside the City, the license must have a City of Liberty Lake Endorsement.
CHECK
ONE BOX BELOW TO INDICATE WHO THE APPLICANT IS
Owner’s Name:
Email:
Phone:
Address:
City, State, Zip:
Contractor’s Company and Contact Name:
Email: Phone:
Address: City, State, Zip:
WA State Contractor License: Contractor UBI Number:
Architect’s Name:
Email:
Phone:
Address:
City, State, Zip:
Civil Engineer’s Name:
Email:
Phone:
Address:
City, State, Zip:
Project Contact’s Name:
Email: Phone:
Site Specific Information
Project Address:
Estimated Value of Project:
Project Description: (Please indicate if you are applying for grading permit only. Grading permits allow only for the removal of vegetation and
general leveling/pad creation- no forms may be placed. If applying for other site improvements, please describe in detail the scope of work.
)
# of cubic yards removed:
# of cubic yards added:
# of cubic yards moved on site:
# of ADA parking spaces:
Special Inspections Required? Yes No (If Yes, please provide the Statement of Special Inspections document)
Are there existing structures on the property? Yes No What is the current property size?
acres sq ft
Is the property within a 100-year flood plan? Yes No Is the property within 250 feet of a shoreline? Yes No
Are there wetlands within 200 feet? Yes No Is there evidence of fill or excavation? Yes No
Are there slopes greater than 30% on the
property (30 ft. rise in 100 ft.)?
Yes
No
( %)
Are critical or hazardous materials used Yes
No
or stored on site? (If Yes, please provide list of materials)
New Commercial / Industrial Multi-Family Residential Residential Other:
SITE IMPROVEMENT PERMIT APPLICATION
Liberty Lake Planning, Engineering & Building Services
22710 E Country Vista Drive, Liberty Lake, WA 99019
Phone: (
509) 755-6726 Fax: (509) 755-6713
Website: www.libertylakewa.gov
Email: permitcenter@libertylakewa.gov
03/26/2019 Page 2 of 2
Required Signatures
BY SIGNING BELOW, I ACKNOWLEDGE THAT A MINIMUM OF 24 HRS. NOTICE IS REQUIRED FOR ALL INSPECTION REQUESTS
Property Owner's Signature
Printed Name
Date
Applicant's Signature
Printed Name
Date
Permit Issuance Option
Would you like to receive your permit / approved plans via email? Yes No
(If yes, please complete the portion below. Once review of your application is complete, we will contact you for credit card payment via phone.)
The permit becomes null and void if work or construction authorized by the permit is not commenced within 180 days of
issuance or if construction or work is suspended or abandoned for a period of 180 days at any time after work is
commenced, unless an extension is granted. Issuance of this permit does not give the authority to violate any federal,
state, or local laws or ordinances, or the building code regulating construction. Separate permits (building, plumbing,
mechanical, sewer, water connection, electrical, etc.) may be required for work performed on this site. Additional permits
/plans may be required prior to Certificate of Occupancy issuance. Contact SRCAA at 509-477-4727 and/or visit
www.spokanecleanair.org
to ensure compliance with air quality regulations. The applicant shall be responsible for
obtaining additional permits/approvals from affected agencies. By checking the box below, I certify that I have read and
understand all of the conditions contained herein and I have the authority to sign on behalf of the applicant. Additionally, I
certify that my signature included on the permit, if done by electronic means, provides the same understanding and
authority as if I had signed the permit in person or writing.
BY SIGNING BELOW, I GIVE MY PERMISSION FOR USE OF MY ELECTRONIC SIGNATURE ON THE PERMIT AND I
ACKNOWLEDGE THAT I UNDERSTAND AND AGREE TO THE TERMS DESCRIBED ABOVE.
Applicant's Signature
Printed Name
Date
BUILDING INFORMATION (PLANNING, ENGINEERING & BUILDING SERVICES OFFICE USE ONLY)
DOCUMENTS RECEIVED AND APPROVAL STATUS:
(check if received/applicable, circle once approved)
Drainage Report APPROVED Site Plan APPROVED
Topographical Survey of Existing
Conditions
APPROVED Site Lighting Photometric Analysis
Plan
APPROVED
Grading Plan APPROVED Details Meet City Detail Standards APPROVED
Storm Water Plan APPROVED Parking Space Count Meets Code APPROVED
Utility Plan APPROVED Landscaping Meets Code APPROVED
PROJECT VALUE:
Notes and Conditions
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

SITE IMPROVEMENT PERMIT APPLICATION (City of Liberty Lake)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document