2002, 04-19 Permit App: 02002746 Reroof • 0,--D_ , - ),:.
1 1 PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
A SPOKANE,WA 99260
509-477-3675
SroicARE COUNTY
SPECIFIC SITE INFORMATION
Street Address: l) /05- e -/�
_��3�6ef U'tel c�
Assessor's Tax Parcel Number(s): /
Legal Description:
Project Description: / Cj
4
7 Building Permit - O Change in Use O Grading Cl Manufactured Home Permit
O Relocation O Sign O Tenant(New/Change) O Other
Depailluent Use Only
Water District/Purveyor Sewer District/Purveyor Road width Setbacks
Front Rear
School District Fire District Zoning
Left Right
OWNER/APPLICANT INFORMATION
121 Indiate who.hos'/d he contacted rexa dingy thi.+peed',t
❑ owner: /t 1 Phone: App- ant: ^ ., \ Phone: g' ?-691y:
'a
- • (//t/t�// -e_:d Lir • Fax: ....• —1 S ( E 4,1 7 A' l 7 Fax: /
t`laing:\JJress, Mailing Address: e) g'°/ - zi,d,e,
(:in-,State,L
4 J�� 99z-05" (:iri,State,Lip
/j n-< W;4– '9 �g
Cont crop phone /��/ , Phone
//_y{/�- �/i�,, �s (,..c ❑ Archncct;fin},nnccr
i& "o,„ /C,L ,5 Fax
Las
,e4,›
Mailing address ,/� ���� /�I Mailing addres
(An-,State Lip - cin-,gate/,ip
\VA State()"cintractor license n Contact name: -
PROJECT INFORMATION
Building Information
Building height to peak #of stones lain floor sq.It. Unfinished basement sq.ft.
Dimensions Total habitable space 2'"4 floor sq.tt. Finished basement sq.It.
Occupancy groupConstruction teesq
P p Garage sq. tt.
Ieck tt.
Cost of project
I feat source!cicctne,gas.rte.)
e
Manufactured Home Sign
Width: Length: What is the square footage of the sign How high is the sign?
face?
Year Make: #of signs ;\rea 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
0 Concrete 0 Welding 0 Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No What is the current property size?
fj'es,identifr 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,idents'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?0 Yes O No
0 Don't know 0 Yes 0 No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
IJjes,ident'on site plan Ifyes,ident f•on the site plan O Yes 0 No
0 Maybe 0 Don't know O Yes 0 No
Arc there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
Ifyes,identifr on site plan 0 Yes O No O 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?
( /°o) 0 Yes 0 No O 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
O Yes O No
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes 0 No
O Yes O No
Is the property inside the PSSA? O,Yes 0 No Is the property located within 1000 feet of a Natural Resource Area?
0 Yes O No
Date Reencrd. Staff Representative:
METHOD OF PAYMENT
SUKIOI•.\l.
VISA
❑ c.\sl l ❑ cl! {CK ❑ =NM ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES: TOTAL FEE
R:\NI:(..\RI)NUMBER: MINIMUM PERMIT FEE IS S310011 OF
>L5IS.CHOCKS P:it.stldl o)sIOK.0 E
SIGNXIURI•:: COUNTY PERMITat\IIiR