2002, 12-02 Permit App: 02010697 Remodel16/.09-
SPOKANE •
4.
PROJECT AIPPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 \\EST BROADWAY AVENUE
SPOKANE, \VA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
210X
Assessor's Tax Parcel Number(s):
e
I,ega1 Description:
Project Description:
f',9"Building Permit
cletc if^�
❑ Change in Use
❑ Grading
❑ Manufactured Homc Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
Department Use Only
` r esu c
Phone: Cx " - 7 Oe i
Fax. ‘14.-- ` sSl
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front:
Left:
Rear.
Right:
r
i
C
Schou) District:
Dire District:
Zoning
OWNER/APPLICANT INFORMATION
ll Indictdt n ho ,hould ht , otrhrdt- •c
mkt: A.
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` r esu c
Phone: Cx " - 7 Oe i
Fax. ‘14.-- ` sSl
❑ :\pplcant
`lye -1,
Slain floor sej. ft.
Phone.
�4
�� J
11ailing.\.1dre s
Total habitable space
2^,I floor sq. ft.
finished basement sq. ft,
\fatting lddre.,s:
Construction type
1'it}. state, Ztp
Deck sy. ft.
Gust of prctjcc/f
Clo, State, /ip
1 !eat source (electric, gait, etc.)
CI j r�>
te
s c j
Phone f2 g-.... =yc
lax
❑ ArchieI.11 neer
Phone
Fax
Mailing address y
77
1
Mailing address
"C p
CtCr, State /tp
rt-Gvv4i
(ah State Zip
\\ A State (: trlc
,nse 4
�'�_Sal TD ,
6" 2—
Contact n
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PROJECT INFORMATION
Building Information
Building height to peak
# of stories
Slain floor sej. ft.
Unfinished basement se ft.
Dimenstons
Total habitable space
2^,I floor sq. ft.
finished basement sq. ft,
Occupancy group
Construction type
Garage sq. ft.
Deck sy. ft.
Gust of prctjcc/f
,61.----60 e6 1 et
0
1 !eat source (electric, gait, etc.)
Manufactured Home
Sign
Width:
Length:
What is the square footage uE the sign
face?"'
I low high is the stgn?
Year:
Make:
# of signs
Arca of existing signs
Value
.\re critical or hazardous materials used or stored on site?
0 Ycs 0 No
A Jdres
Relocation
Fire Safety
Firm Name
What is the current use of this property?
Previous address
i
Paint booth
Fire Sprinkler _
Fire .\farm . _
'lent ..
Fireworks display ..
Proposed use
Value
.\re critical or hazardous materials used or stored on site?
0 Ycs 0 No
A Jdres
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? 0 Ycs 0 No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Yes 0 No
.\ re there slopes greater than 30% % on the property? (30 ft rise in 100 ft)
(—°o) 0 Ycs ❑ No
.\re critical or hazardous materials used or stored on site?
0 Ycs 0 No
A Jdres
Inspector
Phi ne
❑ Concrete
❑ Welding
0 Bolting
0 Reinforcement
address
ITE INFORMATION
Are there structures on the property? ❑ Yes 0 No
1[)PJ, 1de/rti ' oil Jite p/an
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
If yes, identify on .rile plan 0 Ycs 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat arca?
0 Don't know 0 Ycs 0 No
Will the site be served by a septic system? 0 Ycs 0 No
Is any part of thc property within a 100 yr Flood plain?
1fj'es, idenlifi' on site plan
0 -Mavbc 0 Don't know 0 Ycs 0 No
.\ re or \will there he lvcils located on the property?
Illyes, Idem ' on the site plain ❑ Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
1/j'e.r, identify on site plan 0 Ycs 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
.\ re there slopes greater than 30% % on the property? (30 ft rise in 100 ft)
(—°o) 0 Ycs ❑ No
.\re critical or hazardous materials used or stored on site?
0 Ycs 0 No
NLY
Is the property in a designated Storrnwater Control Area?
0 Yes 0 No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA? 0 Ycs 10 No
❑ Yes ❑ No
Is public water available to thc site? ❑ Ycs 0 No
Is the property inside the PSSA? 0 Yes 0 No
Is the property located within 1000 feet of a Natural Resource Arca?
❑ Ycs ❑ No
I >ate Received:
Staff Represen tanve:
METHOD OF PAYMENT
MMINI
VISA
❑ CAST 1 0 CMCK CK ❑ 0 .' ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
BANKC\R1) NI1MBFR:
,\UTI 1ORIZI?1) SIGNATURE:
?SPI RI{S:
SUB'f(YT.\l.
TOTAL FEE
MINIMUM PERMIT FEE IS5.1.5.A9 PLEASE
MAKE CI I LC KS P \l'.\HLE TO SPOKANE
C(1C\'IT PI TAUT CENTER