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2002, 06-17 Permit App: 02004841 Remodel1111 Sroi r(EComy 4V.1 PROJECT APPLICATION WORK SHEET SPOKANiE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 SPECIFIC SITE INFORMATION Street Address: Assessor's Tax Parcel Number(s): C )cD A Oet4rANJAci- QtA Legal Description: Project Description_ O Building Permit O Relocation 1-vo'kQ to - O Change in Use O Grading O Manufactured Home Permit O Sign O Tenant (New/Change) O Other Department Use Only Water District/Purveyor. School District Sewer Distnct/Pun-eyor Road width Fire District: Zoning is Setbacks Front: Left Rear Right OWNER/APPLICANT INFORMATION 0 /ndiw/e who should be eon rep,ardin;, ihir pt e.! Phone: sol JP4.% (;n-, Stare, Zip UPv•K•C33 ift 7 1(2(111)1_ (_ Mailing addr. '. C22 el ' Cin-, State Zi Fax: 0 Applicant: Mailing Address: Phone: City, State, Zip Phonq t f`��.wscrj Fax _. 0 Architect/Engineer Phone Mailing address Fax etc as? City, State Zip Contact name: PROJECT INFORMATION BuilJntg hci lit 11) peak 1)imrnsu ms Building Information # of steric. Main floor sq. li- Unfinished basement sq. ft. (kcupancr group Cost of prnicct I oral habitable space 2'W floor sq. ft. Finished basement sy. ft. (.onstntction tape Game sq. ft. Deck sq. ft. Teat source (electric_ gas. etc-) Manufactured Home Width: Year. Length: Sign !G'th?t is the square footage of the sign face? How high is thc sign? Make: 4 of signs Area of existing signs Relocation Previous address Proposed use Fire Safety Fire Sprinkler Paint booth Fire Alarm Tent Fu-eworls display Value Special Inspections Required? Finn Name Inspectors: Phone Non -Residential Energy Code Compliance? Plans Examiner Phone Address O Concrete 0 Welding 0 Bolting 0 Reinforcement • Inspector Phone Address ADDITIONAL SITE INFORMATION Are there structures on the property? ❑ Yes 0 No fyet, identO, on site plan Is any part of thc property within 250 feet of a shoreline? fjes, idnd jy on _rite plan O Yes 0 No Is your property in a designated wildlife habitat arca? 0 Don't know 0 Ycs 0 No Is any part of the property within a 100 yr flood plain? IJye_r, idents on site plan 0 Maybe 0 Don't know 0 Ycs 0 No What is the current property size? (square feet or acres) What is the current use of this property? \III the site be served by a septic system? 0 Ycs 0 No Are there any wetlands, streams or ponds within 200 feet of the property? Ifyet, Iden!O, on site plan 0 Yes 0 No Are there slopes greater than 30% on the propcm? (30 ft rise in 100 ft) 0 1'cs 0 No Arc or will there be wills located on thc property? f yes, idndift on the site plan 0 Yes 0 No Is there evidence of fill or excavation on the property? O Ycs O No Are critical or hazardous materials used or stored on site? O Yes O No DEPARTMENT USE ONLY Is the property in a designated Stormwater Control Area? O Yes O No Is the property inside the ASA? Is public sewcr available to the site? O Yes O No O Ycs O No Is the property inside the PSSA? 0 .Yes 0 No Dave Received: OYes ONo Is public water available to the site? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area? 0 Ycs 0 No Staff Reptcscnrativa: METHOD OF PAYMENT ❑ (=ASMI ❑ (:IILCk VISA ❑U ❑ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: li\PIRI':s: B; NK(:.\RI) IJU\IBI•:R: _\U 1 I IO1:I %L :I) SIG N.1'I UR I :: SUBTOTAL TOTAL FEE MIN/MUM PERMIT FEE LS SJS.00P1F. SE MA CI IPCI` PAYABLE TO SPOKANE CSW\T' PERMIT CENTER