2004, 05-26 Permit App: BLD-04-04448 RemodelI I
1-11
SPOKANE COUNTY
4
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DEPARTMENT OF BUILDING AND PLANNING
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description:
O Building Permit
0 Change in Use
O Grading
O Manufactured Home Permit
O Relocation
0 Sign
0 Tenant (New/Change)
O Other
I artme it C. s On
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Phone:
Fax:
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Setbacks
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Marling Address:
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OWNER/APPLICANT INFORMATION
Indicate who should be contacted re ardrne this t rorect
0 Owner.
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Phone:
Fax:
❑ Applicant:
Phone:
Fax:
Mailing Address:
1
Marling Address:
City, Siate, Zip
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City, State, Zip
0 Contractor
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Phone
CA CA y'_t
Fax
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❑ Architect/Engineer
Phone
Fax
Mailing address (
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Mailing address
City, State Zip
\
City, State Zip
WA State Contractor license #
te
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Contact name:
Building height to peak
# of stories
PRO ECT INFORMATION
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2nd floor sq. ft.
Finished basement sq. ft.
C\
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
Heat source (electric, gas, etc.)
Manufactured: Home
Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
Year:
Make:
# of signs
Area of existing signs
Previous address
Fire Sprinkler
Paint booth Fire Alarm
Tent
Fireworks display
Proposed use
Value
Special Inspections Required?
Firm Name
Phone
esidential Energy Code Compliance?
Plans Examiner
Phone
Inspectors:
Address
Inspector
Phone
0 Concrete O Welding O Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes O No
If yes, identify on site plan
What 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 O Yes O No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
El Don't know O Yes 0 No
Will the site be served by a septic system? O Yes O No
Is any part of the property within a 100 yr flood plain?
Ifyes, idengy on site plan
0 Maybe O Don't know O Yes O No
Are or will there be wells located on the property?
Ifyes, identify on the site plan O Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
Ifyes, identz on site plan O Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes O No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
a;
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
0 CASH ❑ CHECK 0 11111111111111111 0
❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SUBTOTAL