2002, 09-11 Permit App: 02007821 RemodelLI7
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SPoKANECouvY
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:(...? ) y /'
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Assessor's Tax Parcel Number(s):
Legal Description:
Project Description:
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❑ Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ 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
ule who should be contacted re ardin this hrajed
all Owner
ba in Pc, 9 1-,
Phone: 9 ) k — 3 9 '"' 1
hIn,
❑ Applicant:
Phone:
I as:
Mailing Address:
G ._c I Pitr-(,C
)01
Mailing Address:
2"d Floor sq. ft.
City, State, Zip ,
p o k cr Vv t/ A6
Q
9 1— 06
City, State, Zip
Garage sq. ft.
ElContractor
Phone
Fax
❑ Architect/ I .ngineer
Phone
l..ax
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"d Floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
I leat source (electric, gas, etc.)
Manufactured Home
Sign
Width:
],ength:
What is the square footage of the sign
face?
1 low high is the sign?
Year:
Make:
# of signs .
lrca of existing signs
'Tent
Firc Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
O Ycs O No
Relocation
Fire Safety
Firm Name
What is the current use of this property?
Previous address
Will the site be served by a septic system? O Ycs O No
Paint booth
Fire Sprinkler
'Tent
Firc Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
O Ycs O No
Address
Proposed use
Value
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 Ycs O No
Plans Gxaminer
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
O Ycs O No
Arc there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) O Ycs O No
Are critical or hazardous materials used or stored on site?
O Ycs O No
Address
O No
Is the property Located within 1000 feet of a Natural Resource Area?
D Yes O No
Inspector
Phone
O Concrete
O Welding
O Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures 00 the property? O Yes O No
Ifyes, identify on site plan
What is thc 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 O No
What is the current use of this property?
Is your property in a designated wildlife habitat arca?
O Don't know 0 Yes 0 No
Will the site be served by a septic system? O Ycs O No
Is any part of thc property within a 100 yr flood plain?
If yes, identi/, on site plan
O Maybe 0 Don't know O Ycs O No
Are or will there be wells located on the property?
IEyes, idents on the site plan O Ycs O No
Arc there any wetlands, streams or ponds within 200 feet of the property?
Ifyes, identify on site plan O Ycs O No
Is there evidence of fill or excavation on the property?
O Ycs O No
Arc there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) O Ycs O No
Are critical or hazardous materials used or stored on site?
O Ycs O No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
OYes
0 N
Is public sewer available to the site?
O Yes
0 No
Is the property inside the ASA?
O Yes
OYes
0 No
0 N
Is public water available to the site?
O Yes
0 No
Is the property inside the PSSA?
O Yes
O No
Is the property Located within 1000 feet of a Natural Resource Area?
D Yes O No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
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FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
I':XPIRI?S:
B;\NKC:\RD NUMBI?R:
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SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS S35.00 PLEASE
MAKE CI IPC KS PAYA1t1.E TO SPOKANE
COUNTY PERMIT CFN'ITIR