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2001, 06-06 Permit App: 01004354 Fire Damage Repair-q-3 D 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: N' 4.16/2 5: 15.5 Rd 5p/ �-✓4 Assessor's Tax Parcel Number(s): Legal Description: Project Description: ani a 'ifyt.J L l /--/-‘0b / ! : l L /Are.,v�oFloor— i3uilding Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit ❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ Other Department Use Only Fater Distract/Purveyor. Sewer District/Purveyor Road width Setbacks Front Rear. Left: Right: School District: Fire District Zoning OWNER/APPLICANT INFORMATION El Indicate mho should be roniaeled n tardinL' ibis pTV/e ❑ Owner: Phone: Fa.: C&Y- 4119 `jAir •03 0 ❑ Applicant. Unfinished basement sq. ft. Phone: g/[2.,— 3L32, Ia.: 1.?—,03b r-- Jq«+.es i-SIvoino,-\.. 1314ner- C_'( j' Mailing Address: N. yG/z. S :las gat • Occupancy group Construction type Mailing Address I II3I5",-- Deck sq. It. Cost oh City, State, Lip O 10.4.x. L.1/1. 14 2 l 4 Cin', State, Zip .5;A:,/..-,., r, c -.f4 / 4..?v 4- Contractor r G T .12 Phone Fax 12.2.„ 34,3Z gZ7 - 3070 ❑ Architect;"I:ngdncer Phone Fax I\ failing address "a. (pair T"r's -,--t--- Mailing address City, State Zip Stop-«<_ (--,A �\ 11AoG City, State Zip WA State Contractor license # Contact name: t PROTECT INFORMATION Building Information Building height to peak # of stories \lain floor sq. ft. Unfinished basement sq. ft. Dimensions Total habitable space 2.1 floor sq. ft. Finished basement sq. ft. Occupancy group Construction type Garage sq. ft_ Deck sq. It. Cost oh roic Ct ? I leat source (electric, gas, etc.) • Manufactured Home Sign Width: Length: What is the square footage of the sign face? 1 low high is the sign? Year: Make: # of signs Arca of existing signs Fireworks display Are critical or hazardous materials used or stored on site? 0 Yes 0 No Address Proposed use Relocation ,Fire Safety 1 hirm Name What is the current use of this property? Previous address Will the site be served by a septic system? 0 Yes 0 No Paint booth Fire Sprinkler 'fent Fire Alarm Fireworks display Are critical or hazardous materials used or stored on site? 0 Yes 0 No Address Proposed use Value Special Inspections Required? Non -Residential Energy Code Compliance? hirm Name What is the current use of this property? Phone Will the site be served by a septic system? 0 Yes 0 No Plans Examiner Phone Inspectors: Is there evidence of fill or excavation on the property? 0 Yes 0 No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( °/o) 0 Yes 0 No Are critical or hazardous materials used or stored on site? 0 Yes 0 No Address 0 No Is the property located within 1000 feet of a Natural Resource Area? DYes 0 N Inspector Phone O Concrete O Welding O Bolting O Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? 0 Yes O No If yes, ldenti.fi' 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? If yes, identij, on site plan 0 Yes 0 No What is the current use of this property? Is your property in a designated wildlife habitat area? ODon't know 0 Yes 0 No Will the site be served by a septic system? 0 Yes 0 No Is any part of the property within a 100 yr flood plain? If yes, ideuti/) on site plan 0 Maybe 0 Don't know O Yes O No Are or will there be wells located on the property? If yes, identifj' on the site plan 0 Yes 0 No Are there any wetlands, streams or ponds within 200 feet of the property? Ifj'es, identify on site plan 0 Yes 0 No Is there evidence of fill or excavation on the property? 0 Yes 0 No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( °/o) 0 Yes 0 No Are critical or hazardous materials used or stored on site? 0 Yes 0 No DEPARTMENT USE ONLY Is the property in a designated Stormwater Control Area? DYes 0 N Is public sewer available to the site? 0 Yes 0 No Is the property inside the ASA? 0 Yes DYes 0 No 0 N Is public water available to the site? 0 Yes 0 No 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 VISA ❑ (:Asi 1 ❑ CI 11':(:1-. ❑ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: FXP1 bIS: B.\NL(; \R1) NUMBER: U'1'1 TORI%I{I) S1GNA l VRI(: SUB1'O'1':A1. TOTAL FEE ASE MINIMUM PERMIT FEE IS $35.00PLEASE MAKE CI IACKS PAYABLE TU SPOKANE COUNTY PI:1011T CENTER