2001, 06-19 Permit App: 01004818 Demolition Out Bldg1 t
SPOKANE Coves
•
PROJECT 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: 73 /17— f_ ./4q2/iT ,F •
Assessor's Tax Parcel Number(s): 3 572./ �p7
Legal Description:
p er( 5 1I -c i7 LJ,6Fi /5I7
Project Description: pep -O ( / Tot) t) 0 �►-'�` s!V (JL( L- (y�%
❑ Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
j, Other J rytoi/To"-)
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front Rear.
Left: Right
School District:
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
/nrll,u/e who ,hould he ,ordatied rr2ard/n,' guy IT ail
rAl Owner:(7,47-‘0//c
/ ,,�,
/540Tp ,+77r 0// c
Phone:
I as:
El Applicant
Phone:
las:
Mailing Address: /
-F Q .13)( / y53
Dimensions
Mailing Address:
2"'1 floor sq. ft.
(:itc, State, Zip
SpoKG-og G5A-
l/0
City, State, Zip
Garage sq. tt.
❑ Contractor
Phone
Fax
❑ Architect.Engineer
Phone
I as
Mailing address
Mailing address
City State Zip
City, State Zip
WA State Contractor license 0
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
/6' '
# of stories
/
Main floor ski. ft.
63�
Unfinished basement sq. ft.
Dimensions
Total habitable space
(036.
2"'1 floor sq. ft.
finished basement sq. ft.
Occupancy group
Construction type
Garage sq. tt.
Deck sq. ft.
Cost of project zz
I feat source (electric, gas, etc.)
le c/ R/ c
Manufactured Home '
Sign
Width:
Length: L
What is the square footage of the sign
face?
How high is the sign?
Year:
Make:
# of signs
Arca of existing signs
Fireworks display
Are critical or hazardous materials used or stored on site?
.��
0 Ycs 1l No
Address
Proposed use
Relocation
Fire Safety
Firm Name
What is the current use of this property?
KPw (_
%t
Previous address
Will the site be served by a septic system? O Yes No
Paint booth
Fire Sprinkler
fent
Fire Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
.��
0 Ycs 1l No
Address
Proposed use
Value
Special Inspections Required?
1 Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
KPw (_
%t
Phone
Will the site be served by a septic system? O Yes No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
d Yes )0 No
Arc there slopes greater than 30% on the property? (30 ftrise in 100 ft)
( %) 0 Ycs Pi No
Are critical or hazardous materials used or stored on site?
.��
0 Ycs 1l No
Address
O No
Is the property located within 1000 feet of a Natural Resource Area?
0 Ycs 0 No
Inspector
('hone
O Concrete
0 Welding
O Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Arc there structures on the property? O Ycs O No
Ifyes, ident on site plan
What is the current property size? �/
(square feet or acres) • (‘ AC ren S
Is any part of the property within 250 feet of a shoreline?
Ifyer, identi on site plan O Yes 0 No
What is the current use of this property?
KPw (_
%t
Is your property in a designated wildlife habitat arca?
O Don't know O Yes 1# No
Will the site be served by a septic system? O Yes No
Is any part of the property within a 100 yr flood plain?
Ifyes, identi on site plan
O Maybe O Don't know O Yes M. No
:Arc or will there be wells located on the property?
Ifyer, identz, 011 the site plan O Yes Alf No
Are thcrc any wetlands, streams or ponds within 200 feet of the property?
Ifyer, identifi, on site plan O Ycs JO No
Is there evidence of fill or excavation on the property?
d Yes )0 No
Arc there slopes greater than 30% on the property? (30 ftrise in 100 ft)
( %) 0 Ycs Pi No
Are critical or hazardous materials used or stored on site?
.��
0 Ycs 1l No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
0 Yes
O No
Is public sewer available to the site?
O Ycs
O No
Is the property inside the ASA?
O Yes
O Ycs
0 No
O No
Is public water available to the site?
O Yes
O No
Is the property inside the PSSA?
0 Yes
O No
Is the property located within 1000 feet of a Natural Resource Area?
0 Ycs 0 No
Date Rcccivcd:
Staff Representaticc
METHOD OF PAYMENT
❑ C\SI1 (1 I?CK
VISA
❑ NW=
0
'`("Or.
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I?\P1RI:S:
B:WKCARD NUMBI?R:
\IJI11ORI%I,D SIGN.\TURI{:
SUB101'.\I.
TOTAL FEE
MINIMUM PERMIT FEE IS $35001'11'. \SE
NI 11.1.1 (:I IHCKS P:AS: 5131.!- 10 SPOK NNE
COEN'IN PERMIT CEN TER