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2001, 07-11 Permit App: 01005622 Tear Off, ReroofPROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 SPECIFIC SITE INFORMATION Street Address: ? /1EAJr 1c3b Assessor's Tax Parcel Number(s): Legal Description: Project Description: toe at ❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit ❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ Other Department Use Ont ht nor Phone 0& rkc S LS' it/l'.,, Phone la. NI, Water District/Pune}or.' ' .. - •. .SeCzcDi.tnct/Punerdr ... . • . • - , _ :Road i.kith . . - ',Setbacks Front. - . - - ..Roar' : Righ� ' • " - Sch,i,i1 Distract 1 in. District j'• Cost of pnacct tn, SLID: Zip Po Z. mmg: , .. . . hit OWNER/APPLICANT INFORMATION In b ute mho 'boob! be ,nntaaerl nr,,,b n, ihic pmtnt 9 ht nor Phone 0& rkc S LS' it/l'.,, ❑ Applicant Phone la. NI, ding Addie.. / Mailing Addis.. Dimension.. Cin, State, Zip Cita, State, Zip "^I Odin' It ❑/ Minnie ,,r� 1'hnnc l'kSIl'E---- DOT- I kit -0 rM7-75 Occupancy go nip Phi inc la, hiriling at1, rc.. bp l E- I:- Ait) e( s Mailing :idalrc... Cost of pnacct tn, SLID: Zip Po k A-1 c . ti -)NR" qct r Cm, Gait Zip \\ A 5 m Contractor h ease p tLZ c-3LI Kk_) (,nano name PROTECT INFORMATION — Building Information Building height to peak # of stones ?lain Moony. 0. Lln6nt- hrd basement kg 0 Dimension.. Total habnnble space "^I Odin' It Pinnlirrl bract -nun sy It Occupancy go nip Clot ruction type Garage sy. ti Deck sq. 0. Cost of pnacct 2.. 'n,( 0 neat vine,' (ekanc. tas, tic) Manufactured, Horne , .: .: , ` - Sign "....: ,= .. . Width. Length: What is the square footage of the sign face 11ow high is the sign? Year Make. # of signs Arta of existing signs _ Are critical or hazardous materials used or stored on site?) 0 Yes 0 No Proposed use Value Relocation !-t1: 1 inn Name What is the current use of this property? Previous address Phone Wry Sprinkler 'Tent 1'amt booth 14n Alamo Fireworks display _ Are critical or hazardous materials used or stored on site?) 0 Yes 0 No Proposed use Value Address Special.Inspections Reg' uired?.= :. `"- "., Non -Residential Energy Code'Compliance? ' 1 inn Name What is the current use of this property? Is your property in a designated wildhfe habitat area? ❑ Don't know ❑ Yes ❑ No Phone Is any part of the property within a 100 yr flood plain? Ifyer, identij' on the plan ❑ Maybe ❑ Don't know ❑ Yes 0 No Plans Examiner Phone Impcctors Are there slopes greater than 303o on the property? (30 ft ase in 100 ft) ( /°o) 0 Yes 0 No Are critical or hazardous materials used or stored on site?) 0 Yes 0 No Address Inspector Phone ❑ Concrete ❑ Welding ❑ Bolting ❑ Reinforcement Addrr„ ADDITIONAL SITE INFORMATION Are there structures on the property? ❑ Yes ❑ No If yes, Menlo'', on she plan \\''hat is the current property size? (square feet or acres) Is any part of the property within 250 feet of a shoreline? If res, idea/ fy on rile plan ❑ Yes ❑ No What is the current use of this property? Is your property in a designated wildhfe habitat area? ❑ Don't know ❑ Yes ❑ No Will the site be served by a septic system? ❑ Yes ❑ No Is any part of the property within a 100 yr flood plain? Ifyer, identij' on the plan ❑ Maybe ❑ Don't know ❑ Yes 0 No Are or lvdl there be wells located on the property? flyer. ldenlih' on the tilt plan ❑ Yes ❑ No Are there any wetlands, streams or ponds within 200 feet of the property? If res, idealf' on nee plan 0 Yes 0 No Is there evidence of fill or cm:avation on the property? 0 Yes 0 No Are there slopes greater than 303o on the property? (30 ft ase in 100 ft) ( /°o) 0 Yes 0 No Are critical or hazardous materials used or stored on site?) 0 Yes 0 No DEPARTMENT USE ONLY 15!he property in a designated Stormwater Control Area? . . ❑Yes 0 N . Is public sewer available to the sue? 0 Yes ' 0 No . Is the property inside the ASA? _ 0 Yes 0 Yes 0 No 0 No Is public water available to the sue? 0 Yes "❑ No - Is the property inside the PSS:\? .. - ❑ lyes 0 No Is the property located within 1000 feet of a Natural Resource Area? - 0 Ycs ❑-No - Dale Rua% ed Sur( Rep -meatatn c METHOD OF PAYMENT visa ❑ (:Asn IT cliEcK ❑ ,DIICOVER- •sraegs mi. FAXED PERMITS \C'ILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD D.\'1'1'i I(\1'IRI-S 14A N K(;,\RD NU NIBIIR :\LI'I 11(1RIZHD S ID N.\ I URI SU14I(1'lAI. TOTAL FEE Al/NLifUtl PERMITFE£ ISSlAWi'USNF. d \AI: 011 CIO I'.\i.sI111:'10 SPOKANE. rt1GN I1' P00111 CIN'I ill