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2001, 04-16 Permit App: 01002511 Change of UsePROJECT 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: C_ 47/ / Es ,O/ SI�/3 v — A.4 / C 4 it o 5)0©'t 44.4 _Assessor's Tax Parcel Number(s): Legal Description: (Q Pimt�ts - L2Ve1 j. Project Description: ,4/94e1& %� 176 ,E Building Permit O Change in Use O Grading O Manufactured Home Permit 0 Relocation O Sign O Tenant (New/Change) O Other OWNER/APPLICANT INFORMATION 121 Indicate who should be contacted reeardine this nroiert I ner. CAA. AA. I///tom 6 fr AJC 7 s'a''4i'1c' nor btu ire a un e e' 'z:` F'. F-^�,a-�'43'=i`'-•^ aa'rdtindtit F-"r<'fSnBack°s g"vA' `4Y{� r�s. `zrrRte -s.g".� SiE..:d hoIAtnn 3, y:•is},arv, ,..t,<t: ,,..5...o...r-.:.-.c.. "Dutri$"r}3 y's ` - gin_,,�_,s .3Y=-,_t(t a_. dgr £-�-,GARz.-+�3.2p'Juhs}:f5.1T,.,g4,; . w- "vC«i' . 'f,�SFr,�" v- ^sy'- 'a< fii �o.'Gs.". di))-r' OWNER/APPLICANT INFORMATION 121 Indicate who should be contacted reeardine this nroiert I ner. CAA. AA. I///tom 6 fr AJC 7 Phone: r7/ 77 Q7 Fax. < O / 0 Applicant - Phone. Fax: Mailing Address: 2-1/ 9 5. D/5�-,<M"-ti M1/e...4 nn Mailing Address. Unfinished basement sq. ft. Ciry, State, Zip 5/00.1-04.4-)i` u.4 ?22aC. City, State, Zip Occupancy group 0 Contractor Garage sq. ft. Phone Fax 0 Architec✓Enginecr Phone Fax Mailing address Mailing address Ciry, State Zip City, State Zip WA State Contractor license C Contact name: PROJECT INFORMATION b� d' i ZJ--�'y'P _ -.i�S. �.:i, a.'a.S' nfor atlono- s'•`4, r alaYK26 'N�i�<.��a iF%ft.+Y'Ot Budding height to peak N of stories Main Boor sq ft. Unfinished basement sq. ft. Dimensions Total habitable space • 2 Boor sq. ft. Finished basement sq. ft. Occupancy group Construction type Garage sq. ft. Deck sq. ft Cost of project - Heat source (electric, gas, etc.) manufactures 'One d p' >:£ _ , x k .,...�-.a.. ,,. .�,�_ ��>.-.�. �'��s*��.�:a.:.•� t S>gn;;:��;�.ta�r��kt�s:rr�:�::�;'��.��s x Width: Length: What is the square footage of the sign face? How high is the sign? Year: Make: # of signs Area of existing signs Phone Proposed use Value u1`5wa2re'av ithiit e^z.'Pn'r'. raa s. s'o-.a _ #�.? Relo-catlon " �- k'�:-..4>- � > v'a+"'" u".,3�5' '. -1-`--.• $sz re if•w�iy e.- arc �. yam, t1 'S4l -+. F .e ..,.iY. +�:+Y Slr-si C g "'/SGi• ;: ner e s �a ii 9 ,?, Previous address Fue Sprinkler Tent Paint booth _ Fire Alarm Fireworks display Plans Examiner Phone Proposed use Value u1`5wa2re'av ithiit r Tal nec;,ois .?�Noid�ntif a ' What is the current use of this propert ;: ner e s �a ii 9 ,?, Will the site be served by a septic system? 0 Yes Q-Ntf' - Is any part of the property within a 100 yr flood plain? If yes, identify on site plan 0 Maybe 0 Don't know 0 Yes G -No Finn Name :Phone Is there evidence of fill or excavation on the property? 0 Yes ' Plans Examiner Phone Inspectors. u1`5wa2re'av ithiit Address r x Inspector Phone O Concrete O Welding 0 Bolting O Reinforcement Address 0 Y; 't`eI `c' DDITIONAL SITE I Are there structures on the property> nes 0 No Ifyes, identify on site plan What is the current property size? (square feet or acres) 2. g AC ACIC S Is any part of the property within 250 feet of a shoreline?? If yes, identify on site plan 0 Yes feYNo What is the current use of this propert Is your property in a designated wildlife habitat area? O Don't know 0 Yes Will the site be served by a septic system? 0 Yes Q-Ntf' - Is any part of the property within a 100 yr flood plain? If yes, identify on site plan 0 Maybe 0 Don't know 0 Yes G -No Are or will there be wells located on the property? Ifyes, identify on the site plan 0 Yes Are there any wetlands, screams or ponds within 200 feet of the property? Ifyes, identify on site plan O YesO'No Is there evidence of fill or excavation on the property? 0 Yes ' Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( / %) 0 Yes 0-1c; Are critical or hazardous materials used or stored on site? 0 Yes Or DEPARTMENT USE ONLY th io n siiia td?rStor'ier art - ubh s'a"ew`ei'' -S �` t e?'_ 4 - CI e —© .�..: �"3.' rp rt'r Zs, sii'TAS) J.i � ti u1`5wa2re'av ithiit fl r x •�t�Q e :._;. o" Sin`t5 deft to o - t' rtz ,.. ..'rx.�.tla 0 Y; 't`eI `c' x s . 5"%t." e pr dun Unt icer : f " Eal 1'T- `� . <i '"iT: ._, s -%.«; - Date Received: Staff Representative: METHOD OF PAYMENT • VISA 0 CASH ❑ CHECK ❑ DIJCDVEt FAXED PERMITS WILL ONLY BE ACEPTED WP17-1 PAYMENT OF A MAJOR CREDIT CARD DATE. BANKCARD NUAIBER- EXPIRES: AUTHORIZED SIGNATURE. SUBTOTAL *VPXLFEE LEA _.,yp_ <#:: y11}'r;. ';t`"'s icerciEda RFEEno ST icr MASE"CIiECJCSP:A�'AHL£70 BAIV_E� CatiNrrY.P,ERiatetNtilly i5'`'` SSD goon 2- a -1«-" I3rD ,Zc 0 /37:-.11) Re704.7 3 X29