2004, 10-04 Permit App: BLD-04-07841 Remove, Replace GarageAMR
Spomw Cou ry
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DEPARTMENT OF BUILDING :\ND PLANNING
11126 WEST BROADWAY AVENUE
SPOKANE, \VA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
9C/ /3 L n (ate / <rale- Ade_
Luen 992. o ,
Number(s): 4'C/72 . 120C
Assessor's Tax Parcel
1.egal Description:
Project Description:
LK ISuilding Permit
❑ Change to Use
❑ Grading
❑ \Ianufacmred Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
Department Use Only
Water Dmtr¢t/Ponuor
Seer Di.t rim/run a or
Rana.. gbh
Setbacks
Front Ran -
I.cO Right
School District. -
-
hire District -
Zoning .
-
OWNER/APPLICANT INFORMATION
IZI Imbeale uho t/nu4/ be uutlminl /l¢r NW./
EI h nen ` chime
�t-ec.e 1b• f--/arf I
4q8- -6, a70
O
❑ Applicant
thin.
�a vwc Ia.
Mailing Ade.�dr.- / /
L0) N/ ,. LOC' 0sf
Dimensions
;2q x .2/0 ,V /6
Mailing ArkArkin,'
2"n floor sy. It
t:tr , Stare. Zi i
0
A--4
CJS
99ZC(c
Cri. Stair, Zip
Cost of 110 at_ et U
❑ I:onicutnr
Phone
Fax
❑ r\rchinct/hnpne
Phi re
I'a.
Mailing address
M.alntg address
CO, Slate Zip
cin. State Zip
\\'A State Cont factor license =
Contact name
PROTECT INFORMATION
Building Information
� sass
Budding height to peak
/0
# of scone.
Alam Iloor>y It.
Unfinisli d basement sy fl.
Dimensions
;2q x .2/0 ,V /6
Toni) habitable space
2"n floor sy. It
Ptnnhud ba.unent .y. It
Occupancy group
dins, tion t} peGarage
Tide-t�;ldl�1
sy ft.
Deck sq. 0
Cost of 110 at_ et U
I Ieat source (electric. gas. etc.,
Manufactured Home
Sign
width.
Length:
\4haaa the =quare fuogage of (hi sign
lace-
I 1 iw high n the sign-,
Year
\lobe
# of signs
Area of t\isling stgfa
Phone
Prig nse 1 fisc
Value
Relocation
Fire Safety
Non -Residential Energy Code Compliance?
I'ri , e nn address
1. vriur property in a designated wildlife habitat arca?
0 Don't know 0 Yes ®' No
Fire sprinkler
Tent
Paint booth_ Fire Mann
1 rtw rks display
Plans E'amm.r
Phone
Prig nse 1 fisc
Value
Special Inspections Required?
What is the current property site??
(square feet or acres) 97 X 3/1
Non -Residential Energy Code Compliance?
I inn Name
1. vriur property in a designated wildlife habitat arca?
0 Don't know 0 Yes ®' No
\\iII the site be served by a septic system? 0 Yes Lf two
Phone
Are or wiII there be WAS Iueatcd 011 the propele%
If yes. irlenll jj' 011 Ibe she plan 0 Yee. No
Are there any wetlands, streams or ponds within 200 f.ut of the property?
/ices, nienG(p an the plan 0 Yes No
Plans E'amm.r
Phone
Into:t n.
AJdrt
to p.a•n
ph„„,
❑ (;tmerIA c
❑
\Wc Idmg
❑ lit l ting
0 Rut
cement
AMIE.,
ADDITIONAL SITE INFORMATION
Arc there sit uctures on the property? L 'Ycs 0 No
if yes. Mown. on she?/rut
What is the current property site??
(square feet or acres) 97 X 3/1
Is any part of the property within 250 feet of a shorclin
If yes. idenIl/'onshe plan ❑ \cs Ito
What in'}Lt' current use of this property?
-1-€5/dt-4ce_
1. vriur property in a designated wildlife habitat arca?
0 Don't know 0 Yes ®' No
\\iII the site be served by a septic system? 0 Yes Lf two
Is any part of the property within a 100 yr flood plain;
l%I'es.:deltllf' on she plan
0 I\layhc 0 Dr lir l know 0 les C3 No
Are or wiII there be WAS Iueatcd 011 the propele%
If yes. irlenll jj' 011 Ibe she plan 0 Yee. No
Are there any wetlands, streams or ponds within 200 f.ut of the property?
/ices, nienG(p an the plan 0 Yes No
Is there evidence of fill or excavation on the property?
❑ \cs Nn
Arc there slopes gre:ner than 30°/, on the property% (30 ft tiff�s in 100 ft)
( / Yu) 0 Yes g" -No
Are critical or hazardous 111141 nals used 0r >toad on site
0 Yes L'f No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Arca? -
... ❑\'es 0 N
Is public sewer available to the sae?' ❑ Yes . 0 No
Is the property inside the ASA? - - - 0 l'c• i 0 No
- - ❑Yes 0 N '
Is public water available to the site? - ' ❑ Yes 0 No
Is the property inside the PSSA? . - - 0 Ycs 0 No
Is the property located within 1000 feet of a Natural Resource Arca?
El Yes -0 No
Date Rem ncd
Staff Rrprc.entatnc.
METIIOD Of PAYMENT
❑ C \SI 1 CI IPCK 0
VISA
DIIC•VER
FARED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DA'f1 I?SP112PS
BANKC III) NuMRI:R:
AUI'I I01117.1(1) SIGNATURE.
SUB'I'O 1'AI.
- TOTAL FEE
MINIMUM P£RIr?FPB IS STStGPIA.ASii
?I \Ali CI IECKS r'v.10r10 SPOKANE
COIN tY PERM r CEVIER
=5/ )o4 ae 617'X3(1,
LOCu-ST a..
t_,
3.
'.a
:3
J
•o
17
ADDRESS
ZONE
ROAD WI
FRONT
COMMENTS
REVIEWED BY
ft 1lkOVc-
.e.%is f'n 1 ear
n-ew q a ra e. ax.//x/ 361>140
This site plan is being sebmiesd for the purpose of
obtaining a building permit and is a sue and ported
,elinsentation of the proposal. Al loom
aesmp vertyta
nd
sl
imes dimensions, curb lines, amsuads,
have been identified. op wilco mew
o1 water, s ; slopes
Vac