2002, 03-19 Permit App: 02001717 Pool 0-.2-- n rj
idci PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
lirilik
SPOKANE,WA 99260
509-477-3675
SPoic COUNTY
SPECIFIC SITE INFORMATION
Street Address: io'Srs : e J
Assessor's Tax Parcel Number(s):
Legal Description:
7 i
Project Description: �hi/ in.N,9 !`«9 0 f
io 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:
School District: Fire District: Zoning
Left: Right:
OWNER/APPLICANT INFORMATION
El brdiYa/e who cuould be re failed nnardin;,;this pr jecf
❑owner: Phone: ( q,,,, /5 zr ❑ Applicant: Phone:
par*:.11 / t141 tax: Fax:
Mailing Address: Mailing Address:
/AC/6 E, 5.4 it <e. 1 c',
City,State,Zip City,State,zip
-Sp 0is,„e i )✓i} (?fWW 6'
®Contractor Phone � Phone
A �^'` "' �'� �-.�L7,j-7/ ❑ -lrchitcct/L[n}'tnecr
"i 6 ,7("ka/ L.�` `'rt pt I,-4,tax Fax
Mailing address ,�.�.�r Mailing address
�;4'r/ ' /V ,,x"'1,-0,1 a')
City,State Zip // On',State lip
.._.� o/ciXit e1 kh ??21.,c
AAA S.to Contractor license# Contact name
PROJECT INFORMATION
Building Information
Building height to peak #of stories Slain floor sq.ft. Unfinished basement sq.tt.
Dimensions 'Total habitable space 2'1 floor 54.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project I lent source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: ' What is the square footage of the sign 1 tow 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 0 Bolting O Reinforcement • Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? RI Yes 0 No What is the current property size?
Ifyes,ident'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? 0
If yes,ident on site plan 0 Yes No /1 e S /rd e I1 e c
Is your property in a designated wildlife habitat area? Will the site be served by a septic systemla Yes 0 No
0 Don't know 0 Yes {$ No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
Ifyes,identify on site plan Ifyes,identify on the site plan 0 Yes ttn No
0 Maybe 0 Don't know 0 Yes ,fft.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,identi_bi on site plan 0 Yes 221 No 0 Yes No
Are 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 Al No 0 Yes a No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No
DYes 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?
DYes 0 N
Date Received: Staff Representative
METHOD OF PAYMENT
MEMEM ICOVE: SUB'I'OTA].
VISA
❑ C,ASII ❑ CIII:t5< ❑ ❑ El
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
lla'1'1?: 1?\P1RI?S: TOTAL FEE
BAN hit ARI)NLIMBI'.It: MINIMUM PERMIT FEE IS$35.o0PI LASE
Al‘KE CHECKS PAY STILE TO SPOKANE
AU'17 1081'/111)SIGN:VEURI?: COUNTY PE:R:vIITCENTER
_ ........,.._,,.._..........__________
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1 . This ste plan is being s't mitted for the:-.Jrpose of
\/*
obtaining a building per-7, aid ts a ITJE E..rc,i correct
1 representation of the prcx'osal.AU known property
e lines/dimensions,curt: 'nes.structures ar,d easements t
have been identified. ;,:,... if :;cated are weIlands,
bodies of water,steep
steep z:,,z1;s r other crtical areas.
Signed:
, I
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Date:
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ADDRESS 11-.6" t '5 AL--ccs r
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