2003, 03-28 Permit App: 03002085 Addition lPROJECT APPLICATION WORK SHEET
SPOKANE COUNTiti'DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
I 509-477-3675
SPoK CovirY
SPECIFIC SITE INFORMATION
Street Address: f / fi--ii
/ t � l -1--- I\ V 7x l)T f.J
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: Cil n.t, (� r- C-A "l iq 4I S;/'it G'll'`v'
`4It Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
Department Use Only
Water District/Purveyor. Sewer Distnct/Purveyor Road width Setbacks
Front Rear,
School District Fire District Zoning
Left Right,
OWNER/APPLICANT INFORMATION
El Indicate ubo.rbouId be contacted tgsardinj tbisprojeet
Owner: Phone: (,/}r,,, j j ' I ❑ Applicant Phone:
es//1-tli,e.S 3 `! ij_i `L./ Fax Fax:
Mailing Address: Mailing Address:
/.Z.s>/ .2.: k ,c- k ,z. ,. :,:i
City,State,Zip / Cin-,State,Zip
❑ Contractor Phone Phone
❑ Archi[cctj linjnnecr
^.
a ''t +.` Fax Fax
Mailing address Mailing address
City,State Zip City,State Zip
WA State Contractor license# Contact name:
PROJECT INFORMATION
Building Information
Building height to peak #of stones Main floor sq.ft.{ r� Unfinished basement sq.ft.
Dimensions _ / 'Poral habitable space . ,' 2"d floor sq.ft. Finished basement sq.ft.
/1J 1) X- i ) Ii? v '7, r
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project ffi ) I teat source(electric,gas,etc.)
li
Manufactured Home Sign
Width: Length: What is the square footage of the sign 'low high is the sign?
face?
Year: Make: .F #cif signs Arca 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 O Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No What is the current property size?
Ifyes,identii 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?
If yes,identify 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 0 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?
Ifyes,identi on site plan Ifyes,identify on the site plan 0 Yes 0 No
0 Maybe 0 Don't know 0 Yes 0 No
Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
Ifyes,identify on site plan 0 Yes 0 No 0 Yes 0 No
Are there slopes greater than 309 0 on the property?(30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site?
( /%) OYes 0 N DYes 0 N
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes- 0 No
D Yes O No
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes 0 No
CI Yes 0 N
Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Date Received: Staff Representative-
METHOD OF PAYMENT
MOM
COV E. SUBTOTAL
❑ .-
CASH 0 C1ll (;K ❑ ❑ 0 '-
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DA'fl?: I•.XPIRFS: TOTAL FEE
BANKCARL)N MINIMUM PERMIT FEE IS,f35.A9PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
ATin LORI'/,ND SIGN:VPURI?: COUNTY PERIITCENTER
I
15' S?
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'1 I This site;':gin is being submitted for the pu-nose of
i obtaining a building permit and is a true and correct
1 j x C 1 I representation of the proposal,All known property
I lines/dimensions,curb lines.structures and easements
have been identified.Also indicated are wetlands, LF'
bodies of water teep slopes or oth critical areas,
Signed: 7-'„f--� /
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i /Date:
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ROAD WIDTH
FRONT i:: v 1NG — 1--1)/c?�_ HA C`' .
COMMENTS - � J' t< I.)i I r C- —
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