2002, 03-27 Permit App: 02001985 ReroofPROJECT APPLICATION WORK SHEET
SPOKANE COUNT]• DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, \VA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: S, /,57? ,04wet Rd
Assessor's Tax Parcel Number(s):
Legal Description.
Project Description
Re. ,000
❑ Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Horne Permit
❑ Relocation
0 Sign
0 Tenant (New/Change)
0 Other
•.Departmlit ilise.,0111 '..._.,.
`
.- ...
IX'.tter Ui+tact/Puncyor.•
- ••
,Sewer lhatnct/Pun cynr
i\I:un Ilnur.y It
/v Z8'
Itnad a.iJdt
..
Setbacks,•--
Ptont.
I cit :
`Rrar
- -
Ibgln -
School District -. -
. Fire Distnct'; .-
- -
,,re
'bring . , -
OWNER/APPLICANT INFORMATION
a Inrli ule who •hmdd he . on'e ed re(milrn; Mr. minl
l'a 1 hr ner Phone. 9 ZZ."' 3 s ZS
ten la HgrL R. iMai �i /c� ra. /ra.
0 Applicant
Dunn -
Mailing Aridrs++
S'. 1577 ,lJecu'a
Nailing Addle++
i\I:un Ilnur.y It
/v Z8'
ctp•Sta e. /tp
✓t-xH27gee , wii
qyo- 7
Can, State, Zip
Total habitable space
0 C.ununn„r
Phone
1'a+
❑ :\rchmu/1•ngn a
Pigmy
din
Mailing AJdn++
(actgc sy It ���
hlaihng Ada-,
Cost or protect
/J \
Cain. State Zip
1 neat sournr (cid nc. gas, etc
Cm, State 7''
\\)\ $um Contractor Deng. F
Contact nano
PRO IECT INFORMATION
- Building Information
Budding height in pcnk
# 01 stones
i\I:un Ilnur.y It
/v Z8'
lin lintshrd ba.+. mull sq 0
Dimensions
Total habitable space
T'd tip •r s11. 0.
14ntshed basement .y rt-
( lccupanco go up
t;tmxmctnrn Bre
(actgc sy It ���
aced. >y rt
Cost or protect
/J \
ori
700
1 neat sournr (cid nc. gas, etc
Manufactured Home. -
Sign:
width:
length.
What is the square footage of the sip]
face?
I -low high is the sign?
Year:
Make:
# of signs
i\rea of casting signs
Are there slopes greater than 305% on the property? (30 ft rue in 100 ft)
(/",6) 0 Yes ONO
Proposed use
Value
Relocation' :'
Fixe Safety : ..
ling Name
Proffitt:: address
Phone
h' re Spnnklcr
Tent
Paint booth Bre Alarm
Fireworks display
_
Are there slopes greater than 305% on the property? (30 ft rue in 100 ft)
(/",6) 0 Yes ONO
Proposed use
Value
Special IiispectioiisaRegtked? .,.. [.
Non' -Residential Energy. Code Compliance? ,::
ling Name
What is the current use of this property?
Phone
Will the site he served ht a septic s•stem? O Yes 1 No
Plan. hummer
Phone
Inmectnn
Is there e\idence of fill or exc,tvalion on the property?
0 Yes 0 No
Are there slopes greater than 305% on the property? (30 ft rue in 100 ft)
(/",6) 0 Yes ONO
Are cntical or hazardous materials used or stored on site?
0 Yes 0 No
Address
In.pcnor
Phone
O Concrete
O Welding
O Bolting
O Reinforcetnent
Addres,
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes O No
'Ives. Identify on site pilau
\\•hat is the current property we?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
Ifyea. idenlj' 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 Don't know 0 Yes 0 No
Will the site he served ht a septic s•stem? O Yes 1 No
Is any part of the property within a 100 yr Flood plain?
l f per. Idem j• on the plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
1 fjes. i les/(' on the sire plan 0 Yes 0 No
Are there any wetlands, streams Or ponds within 200 feet of the property?
I/ ye, identify' on site plan 0 Yes 0 No
Is there e\idence of fill or exc,tvalion on the property?
0 Yes 0 No
Are there slopes greater than 305% on the property? (30 ft rue in 100 ft)
(/",6) 0 Yes ONO
Are cntical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
O Yes 0 No
Is public sewer available to the sue? 0 Yes O .No..
Is the property inside the ASA? - 0 Yes 0 No
- 0 Yes 0 N
Is public water available to the site? _. O Yes O"No
Is the property inside the PSSA? 0 Yes 0 No
Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No . -
Date Reran c d
Staff Ri pit.: num c
METHOD OF PAYMENT
VISA
El (;\SI1 ❑ (:Iii : ❑
❑ 'e " ❑
DUCOVER
=.
FAXED PERMITS WILL ONLY I3E ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
D.\I P::
IfNPIRFS.
R \NFC \RD NUMBER -
ALIT' Il11il""/.I •:U SIGN.\ I'UItIS:
SUI -CH MTh
TOTAL FEE
MINIMUM PERMIT FEE 15 V51 PP P1.1:1Sli
\I NM'. CI 11.(11:"I P.W.\/51.1: 109'OS.\ N I.
. t00N"11' PPR\II rCI_N IIB