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