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2002, 09-11 Permit App: 02007821 RemodelLI7 , D t7 (VL) l I 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 /' �i �� S G p : �u L'f A � 5 /�cJ�:Cg6�c�C W l 1 �1 �v b Assessor's Tax Parcel Number(s): Legal Description: Project Description: Orr / c2 Cc( �cx7� e'1 ❑ 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 ❑ C:\SII 0 CI1l:CK 0 ❑ . 0 :10111111 - FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: I':XPIRI?S: B;\NKC:\RD NUMBI?R: 1U'I'I LORI''/,I.D SIGN:A'1'URI?: SUBTOTAL TOTAL FEE MINIMUM PERMIT FEE IS S35.00 PLEASE MAKE CI IPC KS PAYA1t1.E TO SPOKANE COUNTY PERMIT CFN'ITIR