2001, 04-02 Permit App: 01002053 Reroofv'.
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SPOKANE, COUKIY
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: TAW/ L max „ECC 6 re eve a e rcf H4 y9.0 /4
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: 1120c
O Building Permit
O Change in Use
O Grading
O Manufactured Home Permit
O Relocation
O Sign
O Tenant (New/Change)
O Other
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OWNER/APPLICANT INFORMATION
RI Indicate who should be contacted secardmp this project
0 OwnerPhone:
4/(i7t y a /`e,. ^ Fax: P9/Is-dt(
0 Applicant.
Phone
Fax:
Mailing Address-
-1-9/7 E Mayo -e (
Mailing Address:
Dimensions
Cin,,Sum, Zip /�
Cr2enccC.�'e YV / I 9�O
City, State, Zip
Finished basement sq ft.
❑ Contactor Phone
Fax
❑ Architect/Engineer
Phone
Fax
Mailing address
Mailing address
Heat source (electric, gas, etc.)
City. State Zip
City, State Zip
WA State Contractor license p
Contact name:
PROJECT INFORMATION
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Building height to peak
# of stories
Main floor sq ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2"d floor sq. ft.
Finished basement sq ft.
Occupancy group
Construction type
Garage sq. h.
Deck sq. ft
ost ofLpro,-1 3
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Heat source (electric, gas, etc.)
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mnufacture,_omeo
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Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
Year:
Make:
# of signs
Area of existing signs
Value
Address
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Previous address
Fire Sprinkler
Tent
Paint booth Fire Alarm
Fireworks display
_
Phone
Proposed use
Value
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Finn Name
Phone
Are or will there be wells located on the property?
Ifyes, identify on the site plan 0 Yes 0 No
Plans Examiner
Phone
Inspectors-
Are critical ox- hazardous materials used or stored on site?
0 Yes 0 No
Address
Inspector
Phone
0 Concrete
O Welding 0 Bolting
0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
Ifyes, 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 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?
Ifyes, identify on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the
property?
Ifyes, identtfy on site plan 0 Yes 0 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)
( -------.910) 0 Yes 0 No
Are critical ox- hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
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Date Received:
Staff Representative:
METE IOD OF PAYMENT
VISA
❑ CASH 9 CHECK ❑ ❑ :__"__"�'!fl 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DIJCOVER
SUBTOTAL
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