2000, 06-26 Permit App: 00005326 ReroofI 1 PROJECT APPLICATION
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1.026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
SPO CO 509-477-3675
n n ,
Project Description:
TYPE OF APPLICATION
uilding Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
i.'
11
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
Water Dtstnct/Purveyor SewerDtstnct/Purveyor Road width Setbacks
Front Rear
School Dtstnct Ftre Dtstnct Zoning
Left Right
OWNER/APPLICANT INFORMATION
u
0 Indicate who should le contacted regarding this project
❑ Owner:
Phone:
❑ Applicant. Phone:
Fax:
Fax:
Mailing Address:
'
Mailing Address:
City, State, Zip
City, State, Zip
(Contractor
Phone Soe1/� (S -'O6Fq
❑ Architect/Engineer Phone
vytC lh 1 r (fO V0 -C l'Y\
d Y GC
Fax
Fax
Mailing address
kN
Mailing address
Po, z2 3
City, State Zip
S -.vC",
City, State Zip
WA State Contractor license N
Contact name:
Manufactured Home':;.:-:' =
-Sign
Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
year:
Make:
X of signs
Area of existing signs
Relocation
Fire Safety'
Firm Name
Previous address
Fire Sprinkler
Tent
Paint booth Fire Alarm
Fireworks display
_ _
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Proposed use
Value
Address
Special.InspectionsRequired?'
Non -Residential Energy Code:Coinpliance?
Firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? 0 Yes 0 No
Plans Exanuner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(/n/) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
Address
Inspector
Phone
O Concrete
O Welding
O Bolting
n Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
If yes, identify on site plan
\\/hat 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 site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
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 0 No
Are or will there be wells located on the property?
1f yes, identify on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the
property?
If yes, identify on site plan 0 Yes n No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(/n/) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
Isth'c'property ih'a desighafed StoimwategConfrol;Areay
Noi
Is'public,'se ver available to; tf a si"te?
':Is th'e:p'ro}>,e ty inside the
O,,Yes;" .1
pI§'
watei;a vaitalile.tti the siie? '` "O"-Ye's! •-OP'No ublic,
dsahe'property:inside;[he PSSA?t''.
Yes'. iMNo
,Is the p?operip'locatcd`iJiihin 1000 feet:of a Na[ucal'Resource
O; Yes
Date Received:
Staff Representative.