2003, 09-30 Permit App: BLD-03-02627 Change of Usetar L
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY \VENUE
SPOKANE, \VA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
,Assessor's Tax Parcel Number(s):
Legal Description:
Project Description:
❑ Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
El Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front Rear.
Left: Right:
School District:
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
0 Indicate who 5hmuld be on/acted ardinp this Droiet7
ywncr:Phoneheant
OH l UUUH I .
2
1 l �,
las:
Main floor sq. ft.
\ V'— v
Phone
� ( iji,i1Z,}iict_Fax: i — 9.2 A
�, mg Addrts.
l U (!3/
2.'"i Boor sq. ft.
Finished basement sq. ft.
Occupancy group
Mailing Address C
c
Y
, —�
C/ 1y7s
Ci y State, Zip
I,.1-.t.d gars,
Cost of project
, Lz
0707
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14
Ctu Sta iP
A
I'_ t,
- O` 7
CIContractor
Phone
l'ax
❑ Architect/Engineer
Phone
Fax
Mailing address
Mailing address
City, State Zip
City, State Zip
WA State Contractor license #
Contact name
PROTECT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
'Total habitable space
2.'"i Boor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
I teat source (electric, gas, etc.)
Manufactured Home
, ,
Width:
Length:
.t is the square footage of the sign
lace?
I lore high is the sign?
Year:
Make
# of signs
:Arca of existing signs
1'ircrvorks display
Are critical or hazardous materials used or stored on site?
❑ Yes .77 No
Address
Proposed use
Relocation
Fire Safety
I irm Name
What is the current use of this property?
Previous address
Will the site be served by a septic system?,0 Yes ❑ No
Paint booth
Fire Sprinkler
Tent
fire .Alarm
1'ircrvorks display
Are critical or hazardous materials used or stored on site?
❑ Yes .77 No
Address
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
I irm Name
What is the current use of this property?
Phone
Will the site be served by a septic system?,0 Yes ❑ No
Plans Ixaminer
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
❑ Ycs Ja<
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( _ %) ❑ Ycs ,No
Are critical or hazardous materials used or stored on site?
❑ Yes .77 No
Address
Inspector
Phone
❑ Concrete
❑ Welding
❑ Bolting
❑ Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? ❑ Ycs 2 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?
Ifyes, identi.bi on site plan ❑ Yes No
What is the current use of this property?
Is your property in a designated wildlife habitat arca?
❑ Don't know ❑ Ycs ,2r No
Will the site be served by a septic system?,0 Yes ❑ No
Is any part of the property within a 100 yr flood plain?
I Eyes, identz on site plan
❑ Maybe ❑ Don't know ❑ Ycs PrNo
:Are or will there be wells located on the property?
Ifyes, identifi on the site plan ❑ Ycs ,171" -No
Arc there any wetlands, streams or ponds within 20000 .f''et of the property?
Ifyes, identify on site plan ❑ Yes No
Is there evidence of fill or excavation on the property?
❑ Ycs Ja<
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( _ %) ❑ Ycs ,No
Are critical or hazardous materials used or stored on site?
❑ Yes .77 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Arca?
❑ Yes ❑ No
Is public sewer available to the site? ❑ Yes O No
Is the property inside the ASA? ❑ Yes ❑ No
❑ Yes ❑ No
Is public water available to the site? ❑ Yes ❑ No
Is the property inside the PSSA? ❑ Yes ❑ No
Is the property located within 1000 feet of a Natural Resource Arca?
❑ Yes ❑ No
Date Received:
Staff Representative
METHOD OF PAYMENT
VISA
❑ CASA ❑ CIIFCK ❑MEM ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I:APIRFS:
BANKC:AR1) NUMBIR:
AU'1'IIORI/.I?ll SIGN:A1'URI::
SUBTOTAL,
TOTAL FEE
MINIMUM PERMIT FEE IS $35.00PLEASE
ASE
At\KE CHECKS PAYABLE TO SPOKANE
COUNTY PERMrr CENTER
\ALSNCAufzurit- tu_ W11 -(Da g
THESE PLANS MUST BE KEPT
THIS PUILDING,SUBJECT ON THE JOB SITE
T^ 7' INSPECTION CORRECTIONS
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