2002, 12-30 Permit App: 02011251 Demo MH!hi
SPOKAR& COUNTY
0
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF I3UILDING & CODE ENFORCEMENT
1026 \VESC BROADWAY AVENUE
,SPOKANE, \VA 99260
509-477-3675
1
Street Address:
SPECIFIC SITE INFORMATION
/7020/ t %-
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description:
w&
O Building Permit
O Change in Use
❑ Grading
O Manufactured Home Permit
O Relocation
O Sign
❑ Tenant (Neu/Change)
O Other 6 %y -j e-_
IDepartment Use;Only „� °,.�df_,p3
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Roaddll
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'Serb
Front
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Rtghi
School Dssrnce
Fire Dire t
Uccle sy. (1.
17`//
Cast 0rpmjtct
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Leff. d
OWNER/APPLICANT INFORMATION
0 India& mho should be ton/aied remm/rne lbirOniieJ
0 "'ter Phone: '9 P./ 3v y2
7tO2r%t,it Fax.- g)-4 2-04//
0 Applicant
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Mailing Address:
f /77o/ eetta
Mailing Address:
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City. Starr Zip
— 717710
City. state. Zip
Unfinished basement sq. ft.
4e'
Phone );t1 t:nnnac,nr 9,2_9 a -o yO `/
Fax 9)- ? 7/ 0 5
❑ Architen/ling;neer
Phone
Fax
Mailing address
/5 35 /
Mailing address
1 finishman[ ed base.y. fid
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Civ, Stale Zip �/� 2—°
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or
City, Stan Zip -
Constmctro : pe
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\VA State licenzr. 4W`
/q4/— W ‘s# S‘- /7380
Contact name
Uccle sy. (1.
17`//
PROTECT INFORMATION
•
Building Information;.
Building height to pcak
/a
{i bfslones
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Main door sq. ft.
Unfinished basement sq. ft.
4e'
Dimensions
/2- ' ---o
Poral habitable space2nd
72&
floor sy. (1.
/�! q
1 finishman[ ed base.y. fid
y q
Uenipancv group
Constmctro : pe
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Garage <y. (t.
y�
Uccle sy. (1.
17`//
Cast 0rpmjtct
°a
l seat source (electric. gas. etc.)
.
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Manufactured Home . ;'' `.
Sign . '
Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
Year.
Make:
# of signs
Arca of existing signs
Arc there slopes greater than 30% on the property? (30 ft rise in 100 B)
( ....------%) 0 Yes 0 No
Are critical or hazardous materials used or stored 00 site?
0 lyes 0 No
Address
Relocation
Fire Safety
Previous address
Fire Sprinkler
Paint booth Fire Alarm
Tent
Fireworks display
Proposed use
Value
Special Inspections /Required?
;