2000, 04-19 Permit App: 00002830 DemoI I
iiiiiik
HU
SPOKE COUNT/
o- 2$3cb
PROJECT APPLICATION
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
Project Description:
O,=M o c. r ioL) 6 F t4 O u Y cctY41110.
TYPE OF APPLICATION
❑ Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
In Relocation
❑ Sign
❑ Tenant (New/Change)
C]' Other
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
tiC.A.Pk
'//c)-1.9os3
Legal Description:
Department use Only
Water District/Purveyor:
Road width
School District:
Fire District
Zoning
Setbacks
Front:
Left:
Rear:
Right:
OWNER/APPLICANT INFORMATION
El Indicate who should be contacted regarding this project
Owner: 1
QM °LC- t I V\ kAI'\✓-tC/ . /-J
Phone:
Fax:
( S 7) 9(-/.... 9 a)
CSU`) 1L1 -10,E
❑ Applicant:
Phone:
Fax:
Mailing Address:
1 a -y s . ei li
(L
2"d floor sq. ft.
Mailing Address:
Occupancy group
City, State, Zip
VO4,4JP. wiq
99a0c,
Deck sq. ft.
City, State, Zip
Heat source (electric, gas, etc.)
® Contractor
rn i✓€ 5 l L v (_`1
Phone
Fax
❑ Architect/Engineer
Phone
Fax
Mailing address
Mailing address
City, State Zip
City, State Zip
WA State Contractor license #
Contact name:
PROJECT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
L `Otx> FT
Unfinished basement sq. ft.
Dimensions
Total habitable space
2"d floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
Heat source (electric, gas, etc.)
I
Manufactured Home -
Sign
Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
Year:
Make:
# of signs
Area of existing signs
Relocation
Fire Safety
Firm Name
Previous address
Fire Sprinkler
Tent
Paint booth _ Fire Alarm
Fireworks display
Inspectors:
Is there evidence of fill or excavation on the property?
O Yes O No
Proposed use
Value
Address
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? O Yes O No
Plans Examiner
Phone
Inspectors:
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)
( / %) O Yes O No
Are critical or hazardous materials used or stored on site?
O Yes O No
Address
Inspector
Phone
O 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?
O Don't know O Yes O 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?
If yes, identify on site plan
O Maybe O 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, identib 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)
( / %) O Yes O No
Are critical or hazardous materials used or stored on site?
O Yes O No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
O Yes O No
Is public sewer available to the site? O Yes O No
Is the property inside the ASA?
0 Yes
O Yes
O No
O No
Is public water available to the site? O Yes O No
Is the property inside the PSSA?
O Yes
O No
Is the property located within 1000 feet of a Natural Resource
Area? O Yes O No
Date Received:
Staff Representative: