2001, 07-03 Permit App: 01005342 Demolitionlidcl
Aiinik
SPOKE CovNry
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: 1 / 1 6.3 5,„.„4,0 et 1 (/
Assessor's Tax Parcel Number(s): ou \ /3Slee e -T eiX L f: 1 � ( / ) 60C -
Legal Description:
i3 )t
fC
Project Description: D� `\\0\.
❑ Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
El Sign
❑ Tenant (New/Change)
El 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
yule xhn 'Joni(' he , onhaied ardinrojed
(oner: Phone:
:IOWA e � \i ti 1 l - l:ax:
Building height to peak
❑ Applicant
Phone:
Fax:
Nailing Address:
1 aRo 9 6asA- (h, SSu-
Dimensions
Nailing Address:
'"`t floor sq. ft.
City, State, Zip
SQo 1(a& WA 9 Sao Q
Occupancy group
City, State, Zip
Garage sq. ft.
Contractor ` ` �j ( ( Phone co eia) /7
.� 1i6 C \.\ F Xca[ 14Ti tk lax '72 7 �a 1('I
❑ ;Architect; lin},ineer
Phone
Fax
Nailing address
Mailing address
City, State Zip
City, State Zip
\\-,C-Stan Contractor license #
, 12C \&-t co 33 3••
Contact nam
1\401 I—A— /36NAi c -e r -
PROTECT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
'"`t floor sq. ft.
Finished bascmcnt sc. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sc. tt.
Cost of project
I feat source (electric, gas, etc.)
Manufactured Home
Sign
Width:
Length: +
What 1!the square footage of the sign
face?
How high is the sign?
Year:
Makc:
# 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
firm 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
Tent
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?
firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? 0 Yes 0 No
Plans ILsamincr
Phone
Inspectors
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30°'0 on the property? (30 ft rise in 100 ft)
( ........„...--00) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
Address
Inspector
Phone
0 Concrete
0 Welding
0 Bolting
0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
If yes, idem' 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, identi, on site plan 0 Yes 0 No
What is the current use of this property?
Is your property m a designated wildlife habitat area?
0 Don't know O 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?
1f yes, identi(' on ole plan
0 ;Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
Ifyer, identi, on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, 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°'0 on the property? (30 ft rise in 100 ft)
( ........„...--00) 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
0No
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?
D Yes O No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ (;.Asl1 ❑ (:111{CIS
'CIV
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
1):\'I1 ::
1?' I IRI•IS:
B:ANkC:ARI) N1'lRl(R:
AU11I( /F1) SIGN
SUBTO'I'.V,
TOTAL FEE
MINIMUM PERMIT FEE JS S35.0t) PLEASE
MAKE. CHECKS PAYABLE TO SPOKANE
COUNTY PERMIT Ci 11 R