2002, 07-25 Permit App: 02006306 Poolt)
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SPOKANE COUNJY
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY I)IVISIA►N OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
r
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: 1:-P S -1 -al( nti i�
P..
CI Building Permit
El Change in Use
O Grading
O Manufactured Home Permit
D Relocation
O Sign
17 Tenant (New/Change)
4 Other
Department Use Only
Water District/Purveyor:
Sewer District/Purveyor
Road width
Setbacks
Front Rear.
Left: Right
School District
fire District:
Zoning,
OWNER/APPLICANT INFORMATION
El Indicate who should he contacted repardinp this Droied
El Owner:
Building height to peak
Phone:
Fax:
Main floor sq. ft.
Unfinished basement sq. ft.
❑ Applicant:
Phone:
Pax:
Mailing Address:
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Mailing Address:
Cost of proicct
Cin, State, Zip
City, State, Zip
Contractor
A
AA I (�
Cit^, c
lax
S r � O y 0 1
•
El Arch itect/Fngineer
Phone
l:ax
Mailing address
22 C E _
I';?./NCc5
Z Va:;
Mailing address
City, State Zip
City, State Zip
WA State Co tractor license #
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2"it floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of proicct
I [cat source (electric, gas, etc.)
Manufactured Home
Sign
Width:
Length:
What is the square footage of the sign
face?
l Iow high is the sign?
Year:
Make: •-
# of sigms
Area of existing signs
Fireworks display
Are critical or hazardous materials used or stored on sitq_
0 Yes 48t No
Address
Proposed use
Relocation
Fire Safety
Firm Name
What is the current se of this property?
1�-�`' (t c -It-
Previous address
Will the site be served by a septic system? 0 Yes No
Paint booth
Fire Sprinkler
Tent
Fire Alarm
Fireworks display
Are critical or hazardous materials used or stored on sitq_
0 Yes 48t No
Address
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current se of this property?
1�-�`' (t c -It-
Phone
Will the site be served by a septic system? 0 Yes No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Yes AM No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / °'o) El Yes IA No
Are critical or hazardous materials used or stored on sitq_
0 Yes 48t No
Address
Inspector
Phone
0 Concrete
0 Welding
0 Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes .9 No
Ifyes, identi on site plan \
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shore ne?
If yes, ident�� on site plan 0 Yes No
What is the current se of this property?
1�-�`' (t c -It-
Is
Is your property in a designated wildlife habitat a a?
0 Don't know 0 Yes No
Will the site be served by a septic system? 0 Yes No
Is any part of the property within a 100 yr flood plain?
Ifyes, identz on site plan
0 Maybe 0 Don't know 0 Yes No
Are or will there be wells located on the property?
Ifyes, identifi 0n the site plan 0 Yes ANo
Are there any wetlands, streams or ponds within 200,feet of the property?
Ifyes, identz on site plan 0 Yes No
Is there evidence of fill or excavation on the property?
0 Yes AM No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / °'o) El Yes IA No
Are critical or hazardous materials used or stored on sitq_
0 Yes 48t No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
0 Yes 0 No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA? 0 Yes 0 No
DYes 0 N
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSSA? 0 Yes 0 No
Is the property located within 1000 feet of a Natural Resource Area?
D Yes 0 No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ C:\SII ❑ (:uFCK 0 1 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
ILSPIRI•:S:
B:ANKC:AR1) NUMBER:
\UTI TORI'/,11) SIGN:V1'URI::
SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS 05.00PLEASE
MAKE CHECKS PAYABLE 10 SPOKANE
COUNTY PERMIT CENTER
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