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2001, 05-10 Permit App: 01003451 Tear Off, ReroofALA SPOlcA?'WCOUNTY 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: '7167 s' oicd�aw(1 Assessor's Tax Parcel Number(s): Legal Description: -Few off, \Q.C5tt1,9/. Project Description: Tec -r O-IPKesltfvo(� I Building Permit - O Change in Use O Grading O Manufactured Home Permit 0 Relocation O Sign 0 Tenant (New/Change) O Other OWNER/APPLICANT INFORMATION 0 Owner Phone: Wks, 'W -CJI Fax: _.._..._..._... ............. ..ham...•„X .,.,. p. mar 0 A Lcani. FP Phone: Fax: Mailing Address. q 1 I LQ S. M e ito&gl ) Dimensions Mailing Address- 2"^ floor sq h. City, State, lip Sp.l"'w6( Occupancy group Ciry, State, Zip Garage sq. h. 0 Font aor Phone 0A R4OA 5L N(.stPA' fx)/_ 0 Architect/Engineer Phone Fax Mailing address en) U -- ) Zot11J h )10/1, Eden) Mailing address City, State Zip L 1Vizi 4-j L-44 ' of Coy, State Zip WA State Contractor license f Contact name: PR terse <„. r ,V.t > — .na>- Uildittn i ��” " .;r� 's:._s'. ��2""a�t ,a.,a -; " .x. Aor�alion., s r ':;sem -—.-,:"r~.-.§.2s._-t.,-a..�`��;s, Building height to peak rr of .stories Main floor sq. ft. Unfinished basement sq. ft. Dimensions Total habitable space 2"^ floor sq h. Finished basement sq. h. Occupancy group Construction type Garage sq. h. Deck sq. ft. Cost of prole , ZZ DO , 017 bleat source (electric. gas, etc ) �v�p a. r.. ysure vYr:Oi'� V � � ��. . _t i� • Width: Length: What is the square footage of the sign ace? How high is the sign? Year: Make: N of signs Area of enisting signs Previous address Fire Sprinkler Paint booth Fire Alarm Tent Fireworks display Proposed use Value Finn Name Inspcctors: Phone O Concrete O Welding O Bolting O Reinforcement ADDITIONA 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 pan 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? 0 Dods know O Yes O No Will the sire be served by a septic system? O Yes O No Is any part of the property within a 100 yr flood plain? If yes, identify on site plan O Maybe 0 Don't know O Yes O No Are or will there be wells located on the property? If yes, identify on the site plan O Yes O No Are there any wetlands, streams or ponds within 200 feet of the property? If yes, identify on site plan O Yes O No Is there evidence of fill or excavation on the property? O Yes O No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) C--%) O Yes 0 No Are critical or hazardous materials used or stored on site? O Yes O No DEPARTMENT USE ONLY Doc Received Surf Rrpresemaivc METHOD OF PAYMENT VISA ❑ CASH ❑ CHECK ❑ Mow- ❑ ifC©VE'. FAXED PERMITS WILL ONLY BE ACEI'TED WITII PAYMENT OF A MAJOR CREDIT CARD DATE: 3ANKCARD NUMBER. EXPIRES: UINOKIZ ED SIGNATURE SUBTOTAL iii is '� ia._ :;ky Y.r.t. `rAJIITArt/ atstruf s SA0P1t4 "' .: ILiASECJ IECI(S.FAYAB7.ESc3;SPOBiINE��`,' W* -2k ni'_CE hR