2001, 07-17 Permit App: 01005807 Tear Off, Reroof ,‘APROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
11 509-477-3675
SPOKANE COUNTY
SPECIFIC SITE INFORMATION
Street Address: / 3 70 L/ R00%,7.,7
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: Mott" Ail 71— 4e We
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) f3—ether
Department Use Only
Water District/Purveyor: Sewer District/Purveyor Road width Setbacks
Front Rear:
School District: Fire District: Zoning
Left: Right.
OWNER/APPLICANT INFORMATION
(� Indi es/c who should he contacted rpeirdiq Ihi.,project
ClOwner: E3Owner: Phone: Applicant: / Phone: 5//-1 ( ////
(I
C Vl'/"l, �
`//1 ksia f Ilax: Y Y/ r 54 (/L c ./� Fax:
(((YYY
Mailing Address: / Mailing Address: ✓✓✓
1310// C aedi,1 40'7 5
Cite,State,Zip (:itc.State,Zip
❑
Phone
l'honelaxCun[nct r architect [nwurr
Q44 c' lead-47'CFax
Slat ting
address .] Mailing address
/60.7 c000rg ,13
(:ire,State Zip City,State Zip
.VG3/70t yt t4/4- 9V,02( •
WA State Contractor license# Contact name:
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sej.ft. Unfinished basement sq.ft.
Dimensions 'Total habitable space 2"d floor sg. ft. finished basement sej.ft.
occupancy group Construction type Garage sq.ft. Deck sg.ft.
Cost of project I teat source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: What is the square footage of the sign I low high is the sign?
face?
Year: Make: #of signs Area of existing signs
Relocation Fire Safety
Previous address Fire Sprinkler Tent
Paint booth_ Fire Alarm Fireworks display
Proposed use Value
Special Inspections Required? Non-Residential Energy Code Compliance?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
O Concrete O Welding O Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Arc there structures on the property? O Yes O No What is the current property size?
Ifyes,identf on site plan (square feet or acres)
Is any part of the property within 250 feet of a shoreline? What is the current use of this property?
Ifyes,identi#on site plan 0 Yes 0 No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?O Yes 0 No
O Don't know O Yes O No
Is any part of the property within a 100 yr flood plain? Arc or will there be wells located on the property?
Ifyes,identift on site plan Ifyes,identih,on the site plan O Yes O No
0 Maybe O Don't know 0 Ycs 0 No
Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
Ifyes,identify on site plan 0 Yes 0 No 0 Yes 0 No
Arc there slopes greater than 30%on the property?(30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site?
( %) 0 Yes 0 No 0 Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No
OYes 0 N
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes 0 No
DYes 0 N
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 Received: Staff Representative:
METHOD OF PAYMENT
MM. al f SUBlY T\L
VISA ,
❑ c:vsl 1 ❑ ci ll:CK ❑ ❑ 0 --
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
1).\"11',: EXPIRES: TOTAL FEE
B.ANKCARD NUMBER: MINIMUM PERMIT FEE IS$350IPLEASE
MAKE CIIECKS PAYABLE 10 SPOKANE
AUII RAZ] EI)SIGN.Vl'URI:: COUNTY PERMIT CEN'Il