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